BACKGROUND There are few reports about physician and patient attitudes about antiretroviral therapy. Reports on physician perceptions of HIV-positive patients and patients' perceptions of their physicians are even scarcer. METHODS The International Association of Physicians in AIDS Care conducted surveys of HIV-treating physicians, and a separate set of HIV-positive patients. Physicians completed an online questionnaire. Patients completed a written questionnaire. RESULTS Physicians and patients agreed on several issues, including the priority of viral suppression when making treatment decisions and the treatment-limiting impact of side effects. However, they had diverging treatment goals in mind and differing impressions of the type and incidence of side effects. There were also sharp differences in physicians' estimates of how well patients understand HIV disease and its treatment. CONCLUSIONS The differences revealed through these surveys underline the need to conduct a systematic study of physician and patient attitudes about antiretroviral therapy, as well as physician-patient communication.