Vertebral osteonecrosis, also known as Kümmell's disease, is a disorder resulting in non-consolidation of a vertebral fracture caused by ischaemia. The main differential diagnosis of vertebral osteonecrosis is osteoporotic vertebral fracture; however, the former is associated more frequently with severe pain and neurological complications. Although HIV-infected patients have an increased risk of developing osteonecrosis in peripheral locations and osteoporotic vertebral fractures, the occurrence of vertebral osteonecrosis has not been previously reported in any of the large series of HIV-associated osteonecrosis. Here, we report an HIV-infected patient who developed vertebral osteonecrosis with refractory pain and displayed rapid kyphotic deformity development during HAART.