A 40-year-old male, seropositive for HIV-1, diagnosed 2 months back, presented with cough with expectoration, breathlessness on exertion, bilateral edema feet and intermittent fever since 2 months. He had history of painless swelling over the neck with loss of weight and appetite since 1 month. He was started on antituberculous therapy (ATT) since 2 months for pulmonary tuberculosis. On examination, he had diffuse swelling over the posterior cervical region, 4 cmx3 cm, nontender and firm to hard in consistency. On systemic examination, he had muffled heart sounds, bilateral basal crepts and splenomegaly. He had hemoglobin of 6.3 g%, total leukocyte count 8,300/mm3, adequate platelet count, absolute lymphocyte count 747 cells and ESR 32 mm at the end of 1 h. Renal and liver function tests and electrolytes were normal. Mantoux test, sputum for AFB, HbsAg and VDRL were negative. His CD4 count was 166 cells/mm3. The chest radiograph showed superior mediastinal widening and cardiomegaly. Sonography of the chest and abdomen showed minimal pericardial effusion and splenomegaly with extensive periportal lymphadenopathy. He had dilatation of all four chambers of the heart [left ventricular ejection fraction (LVEF), 72%] on echocardiography. CT of the chest and abdomen showed extensive mediastinal and abdominal lymphadenopathy. Fine needle aspiration revealed multinucleated Reed Steinberg (RS)-like large cells with abundant pale cytoplasm, with lobular nuclei and coarse chromatin. Lymph node biopsy showed RS cells and dense fibrous tissue. RS cells expressed CD 30 and were negative for LCA, CD20, CD15 and EMA. A final diagnosis of Hodgkin's lymphoma, nodular sclerosis type-II (Ann Arbor stage IV-A) was made. The patient received six cycles of low-dose and two cycles of standard-dose CHOP therapy with ART, consisting of Stavudine (d4T)+Lamivudine (3TC)+Nevirapine (NVP) along with Digoxin. After eight cycles, the patient was asymptomatic, with reduction in neck swelling and weight gain. His CD4 improved from 166 to 247 cells/mm3, with reduction in size of the mediastinal and abdominal lymph nodes on sonography and CT scan.