From the start of the HIV epidemic, respiratory failure has been the most common indication for patients with HIV infection to be admitted to ICU. In the era of cART, PCP, bacterial pneumonia and tuberculosis continue to be significant causes of respiratory failure; however, admission to the ICU with non-HIV-associated respiratory causes, including emphysema and asthma, is increasingly encountered. An emerging cause of respiratory failure requiring admission to the ICU is immune reconstitution inflammatory syndrome (IRIS). Non-respiratory causes, including renal and hepatic failure, cardiac disease, drug overdose and severe toxicity from HIV therapy are increasingly recognised. Early in the HIV epidemic, HIV-seropositive patients with critical illnesses were deemed incurable. ICU mortality rates were high and long-term survival rates were low. The majority of admissions to the ICU were patients with severe PCP. As a direct result of cART, there has been a sustained reduction in HIV-associated morbidity and mortality. Several studies report improved outcomes for HIV-seropositive patients requiring admission to the ICU in the cART era. One recent study suggests that outcomes from ICU admission for HIV-seropositive patients are equivalent to those for the general medical (non-HIVinfected) population. Improved survival from HIV-associated PCP after 1996 has been shown to be independent of the use of cART and likely reflect general improvements in the ICU management of acute lung injury.