The British HIV Association, in association with the British Infection Association, has produced guidelines on the management of opportunistic infections in individuals living with HIV. Opportunistic infections remain a major clinical challenge emphasising the key role of early testing and getting individuals on antiretroviral therapy before their CD4 T-cell count drops to levels that put individuals at risk of opportunistic infection. We emphasise the changing pattern of opportunistic infections and the importance of considering what constitutes an opportunistic infection in the era of effective combination antiretroviral therapy as well as the increasing burden of geographically restricted infections. Key areas of when to safely stop prophylaxis against opportunistic infection and when to start antiretroviral therapy after treatment of an opportunistic infection are discussed.