Chronic kidney and end-stage renal disease are important complications of HIV disease and treatment. African Americans with HIV infection are at significantly increased risk for development of chronic kidney disease and for progression to end-stage renal disease. Survival of HIV-positive patients on dialysis has improved dramatically since the introduction of combination antiretroviral therapy, with hemodialysis and peritoneal dialysis appearing to offer similar survival. Renal transplant has been shown to be successful in HIV-positive patients and emerging data suggest a survival benefit over remaining on dialysis, despite data indicating an increased incidence of acute rejection. Immunosuppression dosing is complicated by interactions with antiretroviral therapy, and drug levels must be followed closely. Experience to date suggests that HIV-positive transplant recipients are best cared for in academic institutions with multi-disciplinary teams devoted to their care.