Changing patterns of HIV-associated diseases and their management pose new challenges for the cytopathologist. The reduced frequency of PCP is replaced by different, often more mundane infections which may need specific means of detection and culture. The increased incidence of neoplasia has uncovered new viral associations and seen the emergence of new entities, some of which may be apparent only in cytological material. The increased prevalence of CIN lesions gives rise to raised cervical smear surveillance, and may pose management difficulties for cytology and colposcopy services. Cytopathologists should be aware of developments in the HIV spectrum of disease in order to anticipate possible changes in their own working practices.