A 46-year-old Hispanic male with a history of intravenous drug abuse and sexual promiscuity received a cadaveric renal transplant in January 1984. He tested positive for HIV- 1 in February 1986. Infectious complications began 19 months after transplantation and were managed successfully until his death from sepsis 109 months posttransplant. Other HIV-infected long-term solid organ transplant survivors are reviewed from the literature. The effects of prednisone and cyclosporine on HIV- 1 expression are discussed briefly.