Since the advent of human immunodeficiency virus (HIV) in 1981, the availability of highly active anti-retroviral therapy has transformed this condition from a death sentence to a highly manageable condition. Unfortunately, a large proportion present late, resulting in increased mortality and morbidity and ultimately an increased risk of forward transmission. Oral manifestations are among the earliest and most important indicators of infection, suggesting a decreased CD4 T-cell count and an increased viral load. In the UK, a large proportion of patients are diagnosed with a CD4 count <350 cells/mm3, which is below the recommended threshold for commencing HIV treatment. This case reinforces the importance of considering HIV in the differential diagnosis of an oral lesion, consolidates our knowledge of oral lesions associated with immune suppression and discusses the implications of late diagnosis.