Although proving its effectiveness in suppressing human immunodeficiency viral (HIV) replication, atazanavir has also recently been associated with cardiac QT interval prolongation and ventricular arrhythmia. The connection rouses larger concern when other proventricular arrhythmic conditions or drugs are concomitantly involved. We present a case of a HIV-infected patient with liver cirrhosis who developed QT interval prolongation in the setting of atazanavir. Subsequently, this arrhythmia progressed to near lethal torsades de pointes while acutely coupled with an exacerbating high-dose oxycodone therapy. Once atazanavir was discontinued, QT interval times progressively normalized, and ventricular arrhythmia risk was alleviated. In conclusion, this observance encourages physicians caring for HIV-infected patients to be aware of this possible rare but emerging cardiac presentation during the treatment of patients on atazanavir therapy.