According to guidelines from WHO, and with his characteristic skin lesions, histopathological findings, definite sensory loss, and a history of residence in Oman (a country endemic for leprosy), a diagnosis of borderline tuberculoid leprosy was made. HIV prevalence in patients with leprosy is not increased compared with the general population, and the clinical spectrum of leprosy is not affected by HIV co-infection. Because of the extremely high lesion count in our patient, we speculate that HIV might have had a role in disseminating the disease over the body by altering peripheral M leprae-specific CD4 lymphocytes without affecting the local immunological reaction and the granuloma formation per se.