A nasopharyngeal carcinoma was the first event in an otherwise symptom free HIV person. No reports of simultaneous nasopharyngeal carcinoma and HIV infection are known to us. A 46-year-homosexual man was admitted to the ENT department with a three week history of pain in the throat referred to the left ear. He was found to have an irregular tumour in the nasopharynx with a lymph node metastasis to the left side of the neck. The poor response to radiotherapy and the very aggressive progress after treatment raised suspicion of a co-existing disease process. The risk of sexually transmitted HIV was confirmed post mortem and could explain the rapid progression of the tumour. No anti-HIV treatment was given concurrently with radiotherapy.