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Respiratory infections remain a major cause of morbidity among HIV-infected persons. Thus, knowledge of recent advances regarding HIV-associated opportunistic pneumonias is crucial for optimal care of HIV-infected persons.Bacterial pneumonia is the most common HIV-associated opportunistic pneumonia in the USA and its incidence remains appreciable. Worldwide, tuberculosis dominates the clinical picture. The absence of rapid, affordable diagnostics for active and latent tuberculosis remains a major obstacle that must be overcome if the global epidemic is to be slowed. The specter of extensively drug resistant tuberculosis and its overlap with HIV infection highlight the importance of rapid diagnostics and the need for accessible drug susceptibility testing. Pneumocystis (carinii) jirovecii pneumonia appears to be a more common pneumonia among HIV-infected persons residing in developing countries than was previously appreciated. Similar to tuberculosis, the absence of available diagnostics in developing areas is a major obstacle to clinical care and epidemiologic studies. The critical care of HIV-infected persons is challenging.Although tremendous advances have been made in our understanding of the management, treatment, and prevention of HIV and its associated respiratory infections, significant gaps remain. Thus, continued epidemiologic, clinical, and bench research is needed.