An infrequent thoracic and abdominal aortic aneurism occurred in a patient with a human immunodeficiency virus (HIV) infection well controlled by an effective combination antiretroviral therapy, already modified to minimize dysmetabolic abnormalities. No adjunctive risk factors for an accelerated atherogenesis were present (ie, cigarette smoking, arterial hypertension, metabolic syndrome, diabetes mellitus), the personal and family cardiovascular history were mute, and no infectious foci supported a mycotic aneurism. Moreover, alternative statin-fibrate therapy was administered since 18 months, and a diet-exercise program and a polyunsaturated fatty acids supplementation were recommended. Despite surgical positioning of an aortic endoprosthesis immediately after diagnosing the aortic aneurism, 11 months later an imminent aneurism rupture was avoided by the introduction of another endoprosthesis between the older thoracic graft and the suprarenal prosthetic device, although a revascularization of renal and mesenteric arteries became needed. The subsequent, 7-month-long follow-up did not disclose complications or sequelae, whereas HIV infection remained under control with a simplified, effective, and well-tolerated antiretroviral regimen. Unfortunately, a fatal relapse of ruptured aortic aneurism led rapidly our patient to death. Caregivers following HIV-infected patients should be aware of the increased risk of complicated, accelerated atherogenesis in these subjects, even when combination antiretroviral therapy is sufficiently well tolerated, and the great majority of known risk factors has been assessed and eventually treated. Severe gross vessel abnormalities deserve major attention and eventual specialistic surgery treatment, which may play an effective role in life-threatening conditions.