Introduction: As it is a disseminated disease, HIV infection can be associated with significant cardiovascular and neurological complications; however, this commonly occurs late. Here, we highlight the unusual initial presentation of HIV infection, which is myocardial infarction complicated by stroke.Case Presentation: A 30 years old male with a clear medical background presented with severe chest pain with evidence of ischemia on ECG and positive serum troponin. he received anti-ischemic drugs, and was prepared for coronary angiography with routine investigations tested positive for HIV; however, his condition was later complicated by stroke. Conclusion: The presentation of acute coronary syndrome in a young patient should raise suspicion of uncommon causes and needs prompt evaluation from digging up in history, detailed examination and investigations with close follow-up to prevent the complications that may occur. on the other hands known HIV Patients should be screened periodically with electrocardiogram