More than 25 antiretroviral drugs from six therapeutic classes are now available for the management of HIV infection (box 1). Most patients who take medication achieve durable and perhaps lifelong viral suppression, so the classic AIDS related conditions are becoming less common. However, treated patients do not have completely restored health. Compared with people without HIV infection, patients with the infection who are treated with antiretrovirals have increased risk for several “non-AIDS” complications, many of which are commonly associated with ageing (box 2). This risk is particularly evident in patients whose CD4+ T cell counts are below normal during long term treatment, but it is also seen to some extent in those with higher CD4+ T cell counts. As a consequence of the changing spectrum of HIV associated disease, the medical management of HIV infection is evolving—a lower proportion of time is now spent managing drug resistance and short term toxicities and a higher proportion is spent managing these premature age associated complications. This review discusses the evidence that the major complications of “treated” HIV disease—including cardiovascular disease, malignancy, renal disease, liver disease, bone disease, and perhaps neurological complications, which are phenomena of the normal ageing process—occur at an earlier age in the HIV infected population. The implications for clinical management are also discussed.