Thanks for your question.
I believe that the issue with coronary heart disease and HIV remains unclear; there have been some warning shots that appear to implicate an increased incidence among persons with HIV, particularly among those receiving protease inhibitor-containing therapy. A intriguing, large prospective study from an Italian group was presented at this years World AIDS Confernence. In this study, over 1500 treatment naive persons were randomized to receive either protease- or non-nucleoside-based HAART. There was a significant increased incidence of heart events over a three year period among the group receiving protease inhibitors. Similar risk-associations have been seen in some North American cohorts, including the CDC's HOPS study (presented, as well at the World AIDS Conference by Holmberg).
The difficulty here is that there is little information to guide us as to the absolute incidence-- some larger cohort studies actually have failed to show an increased incidence overall; particularly when controlled for age, gender and other CAD risk factors.
I'd think that the absolute risk for a recently diagnosed 20-something is going to be awfully low-- pathogenetically, I think that even if HIV is found to be a risk factor in premature heart disease, that the duration and severity of HIV disease, as well as other cofactors, like medications or coinfections would require a relatively longer "incubation" period-- hence low risk in your 20 year old patient.
I hope this helps- thanks for writing. -BY
