This report describes a rare case of a 39-year-old male with a history of long-term intravenous heroin addiction, nasopharyngeal carcinoma, and chronic hepatitis B and C, who developed acute septic arthritis of the bilateral hips. Arthrotomy and debridement of both hips were first performed. Based on the patient's immunocompromised condition, human immunodeficiency virus (HIV) infection was suspected and confirmed by Western blot test 3 days after operation. Although septic arthritis of the hip is a surgical emergency, a high index of suspicion is required for the diagnosis of HIV infection in drug addicts with multifocal septic arthritis. Such suspicion is crucial for surgeons to take adequate protection.