The proportion of older (aged ≥50 years) people living with human immunodeficiency virus (PLHIV) within the HIV-positive population is increasing. Many comorbidities associated with ageing are observed more frequently and/or occur at an earlier age among PLHIV, compared with people who are uninfected. The aim of this article is to improve the confidence of treating physicians who have limited HIV experience in providing care for the increasingly elderly HIV population by presenting a contemporary clinical picture of older PLHIV and discussing the key evidence-based principles of management, with reference to data in the Australian setting where applicable. Older PLHIV, in particular those with complex comorbidities, are likely to benefit from comprehensive multidisciplinary medical and psychosocial support as they age. Physicians are well placed to diagnose and treat HIV as early as possible in older people and ensure counselling to prevent secondary transmission of HIV.