Respiratory complaints are a common reason for patients with HIV infection to present to an emergency department (ED). “HIV and shortness of breath” is one of the most frequent chief complaints on ED triage sheets, and the differential diagnosis is broad. Pulmonary etiologies include infectious and noninfectious causes that are related and unrelated to underlying HIV infection and range from the minor to the life threatening. This article focuses on respiratory emergencies among HIV-infected patients and discusses their typical presentation and diagnostic evaluation as well as therapeutic interventions that should be initiated in an ED.