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Patients with HIV infections are 4 1/2 times more likely to die suddenly from cardiac arrest than people without HIV, even if the virus is under control and they appear relatively healthy, according to a UCSF study.

The report, published Monday in the Journal of the American College of Cardiology, found that sudden cardiac death - which occurs when the heart unexpectedly stops beating - was the second-most common killer among HIV-positive patients. AIDS was the most common cause of death.

Researchers involved in the 10-year study believe no single cause is involved but say HIV patients and their doctors need to be more vigilant about being screened and treated for heart disease risks like high blood pressure and high cholesterol as their lives are being extended by antiretroviral drugs.

"Cardiac disease is a big issue as these people are living longer," said Dr. Zian Tseng, a UCSF electrophysiologist and lead author of the study. "HIV providers need to be aware of the risk of these patients dying suddenly."

Over the past two decades, the treatment of HIV has changed dramatically with the success of antiretroviral drugs. The medications can, in many people, suppress the virus to the point where it's undetectable in a patient's blood, and doctors have begun to see HIV infection as a chronic condition and not a death sentence.

But the trade-off is that the virus does damage over time, and perhaps so do the drugs used to treat it. Add to that the fact that HIV patients were slow to adjust to the idea that they could live much longer on the drugs, said Dr. Priscilla Hsue, director of the HIV Cardiology Clinic at San Francisco General Hospital and an author of the UCSF study.

They were reluctant to stop lifestyle choices that contributed to heart disease, such as smoking or heavy drinking, she said. But patients, and their doctors, are beginning to understand, and their thinking is changing, Hsue said.

"Now they're thinking, 'I could live another 25 years if I take care of myself,' " Hsue said. "And I'm really hammering on stop smoking, take blood pressure medication, watch your cholesterol."

The study looked at 2,860 HIV-positive patients who were treated in San Francisco General Hospital's HIV/AIDS ward from 2000 to 2009. In that period, 230 died - 57 percent of them from AIDS, 13 percent from sudden cardiac death, 11 percent from other natural diseases, and 19 percent from suicides, overdoses or unknown causes.

Notably, 86 percent of all cardiac deaths among those patients were sudden. In the general population, the number of sudden deaths is about half of those who have heart-related deaths.

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Study: Sudden heart death high among HIV patients