Survival of patients with HIV admitted to the ICU has improved substantially in the last 10 years, with HIV patients now being able to expect a similar chance of survival through to hospital discharge as general medical patients admitted to the ICU. The basis for this improvement is likely to be multifactorial, reflecting better understanding of HIV-associated disease, the availability of new combination antiretroviral therapy, the improved care of HIV patients both outside and within the ICU, and protective ventilation strategies for HIV patients with respiratory failure and acute lung injury.