Background and Objectives: Avascular necrosis of femoral head is a common entity. Avascular necrosis of femoral head due to anti-retroviral therapy is an emerging health problem in the world. In India, avascular necrosis of femoral head due to anti-retroviral therapy is not yet reported. We report a case of bilateral avascular necrosis of femoral head as a complication of anti-retroviral therapy. Material and methods: A 41 year old female, a known case of pulmonary tuberculosis had anti tuberculous treatment. While she was on anti tuberculous treatment, she was diagnosed for human immune deficiency infection and put on stavudine, lamivudine and efavirenz [transcriptase inhibitors] and continued for one year. Results: In the follow up period of our patient, she was found to have low back pain and pain in right hip and limp and she was diagnosed of having bilateral avascular necrosis of the femoral head. The diagnosis was confirmed by biopsy of both the femoral heads which revealed avascular necrosis. Interpretation and conclusion: Till date avascular necrosis of the bone due to anti-retroviral therapy is not yet reported from India. We report this case for its rarity and to stress the role of MRI in early detection of avascular necrosis of hip in patients with anti-retro viral therapy.