BACKGROUND Our goal was to analyze whether the presence of human immunodeficiency virus (HIV) infection effects outcome after trauma. METHODS We performed a retrospective review of trauma patients from 2000 to 2005 comparing HIV-positive patients with HIV-negative patients. RESULTS A group of 54 HIV-positive patients were compared with 200 HIV- negative patients who were equally matched for demographics, mechanism, and injury severity. The groups had similar comorbidities except for more coagulopathy (0% vs. 3.7%, p = 0.04) and renal failure (0.5% vs. 9.3%, [p = 0.002]) in the HIV-positive group. The HIV-negative group had 9% overall complications versus 22.2% for the HIV-positive group (p = 0.02). There were more respiratory (0.5% vs. 5.6% [p = 0.03]) and renal (0% vs. 5.6% [p = 0.009]) complications in the HIV-positive group. No differences were found between the groups regarding ventilator, intensive care unit, hospital lengths of stay, or mortality. In the HIV-positive group, 34 had known CD4 counts which averaged 474.6 cells/muL +/- 457.4 cells/muL. There were eight who had a CD4 count less than 200 cells/muL of whom two had complications, and one had an infectious complication. These were not statistically different from those who had CD4 counts >/=200 cells/muL. Regression analysis did not demonstrate any difference in overall complications (p = 0.37) or infections (p = 0.38) regardless of the CD4 count. CONCLUSION Although HIV-infected patients suffer more complications than their noninfected counterparts, HIV does not alter the outcomes for trauma patient. HIV status should not influence management decisions for these patients regardless of the patient's CD4 count.