During 1985 to 1999, the percentage of hemodialysis centers providing care to patients with human immunodeficiency virus (HIV) in the United States increased from 11% to 39%, and the percentage of dialysis patients with HIV infection increased from 0.3% to 1.4%. Therefore, nephrologists are going to be confronted not only with providing dialysis care, but also with primary care issues of these patients. In this review, we discuss issues related to HIV infection and end-stage renal disease, such as choice of renal replacement therapy, vascular access, anemia, vaccination, prevention of opportunistic infections, and antiretroviral therapy, that will help nephrologists not only provide optimal care, but also improve outcomes in these patients.