It has been suggested that the immunosuppressed state associated with HIV infection may influence the clinical course of rheumatic diseases. We describe the case of a patient with moderately advanced HIV infection who developed a psoriatic rash and a rapidly progressive spondylarthropathy of the cervical spine with atlantodental subluxation requiring spondylodesis. This case supports the hypothesis that HIV infection may be associated with uncommon manifestations and a rapidly progressive course refractory to medical therapy in patients with spondylarthropathy.