In this report the authors describe a patient in whom pneumococcal spondylitis was the presenting manifestation of HIV infection and discuss bone and joint infections during HIV infection. The case report involves a 43-year-old man from Mali who was admitted for fever and back pain that occurred during upper airway infection. Pneumococcal spondylitis was diagnosed based on MRI images showing an epidural effusion and on positive hemocultures for Streptococcus pneumoniae. Initial standard x-ray findings were normal but repeat imaging revealed the disco-vertebral lesions. HIV serology was positive but there was no evidence of immunodepression or decreased CD4 lymphocyte levels. Since the introduction of antibiotics bone and joint involvement in pneumococcal disease has become uncommon in developed countries. In patients with HIV infection pyogenic arthritis is rare but the risk of pneumococcal disease is greatly enhanced and arthritic lesions can occur. Only eleven cases of pneumococcal arthritis associated with HIV infection have been reported in the literature. However the incidence of these infections seems higher in Black Africa where they account for 50% of pyogenic arthritis. The authors emphasize the lack of correlation between the stage of HIV infection and the onset of pneumococcal osteoarthritic infections which could account for occurrence of the latter as presenting manifestations of retroviral seropositivity.