Sir,

I read with interest the case report by Agnihotri et al., on the hydatid disease (HC) of the spine.[1] It is obvious that HC is an important zoonotic disease worldwide, including India. The available data pointed out that 5.03% of individuals asymptomatic for HC in India were found to be seropositive to Echinococcus granulosus antigen by serology.[2] Interestingly, the incidence of HC at unusual sites was noticed to be higher in India than in other parts of the world.[3] Individuals infected with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome are more vulnerable to a wide range of zoonotic infections, including HC due to impaired cellular and humoral immunity. To the best of my knowledge, HIV infection is still a major health threat in India. The current national prevalence is about 0.26% compared with a global average of 0.2%.[4] I presumes that the authors did not specifically consider underlying HIV infection in the studied patient as they mentioned that “all the hematological investigations were normal.”[1] Contemplating the diagnostic set of estimating CD4 count and viral overload was solicited. If the aforementioned diagnostic set was done and it disclosed underlying HIV infection, the case in question could be considered a novel case report in India as HIV-associated primary spinal HC has been rarely reported in the literature so far.[5]