Respiratory disease remains a common cause of morbidity and mortality in HIV-infected patients. The spectrum of disease is broad and includes infection, malignancy, airway, parenchymal, pleural, and vascular pathology. The pattern of disease has changed markedly in populations where combination antiretroviral therapy (cART) is available; the incidence of many opportunistic infections and malignancies has fallen, although rates remain higher than in the general population, and conditions such as chronic obstructive pulmonary disease and lung cancer are increasing as life expectancies rise. Controversies still remain over the timing of cART in relation to the treatment of opportunistic infections such as tuberculosis, and the diagnosis and treatment of the immune reconstitution inflammatory syndrome (IRIS). © 2013 Elsevier Ltd. All rights reserved.