The global increase in the number of patients with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), especially in the developing world, has posed a major challenge to clinicians in the management of these patients. Tuberculosis is the commonest opportunistic spinal infection. Spinal trauma is encountered in young active patients with the early stages of the disease and rarely in patients with AIDS. Malignancy with spinal involvement is usually noted in terminal AIDS patients. The outcome following treatment depends on the stage of HIV infection, CD4 (cluster of differentiation 4) cell count, nutritional status and the presence of comorbidities including opportunistic infections. Health care workers (HCW) are at risk for disease transmission including hepatitis. This review provides guidelines for the classification of the immunocompromised patient, relevant investigations, including staging, management and outcomes, following the treatment of spinal pathology in patients with HIV/AIDS.