With the introduction of effective antiretroviral therapy for the treatment of human immunodeficiency virus infection in 1996, there has been a surge of patients with body contour abnormalities that present with central fat accumulation and peripheral fat loss. Fortunately, there are many surgical approaches to help patients with these deformities. Loss of volume and projection, hip narrowing, widening of the intergluteal cleft, persistent dermatitis and ulcers characterize the gluteal deformities seen in these patients. A classification of gluteal lipoatrophy is presented in this chapter in order to adequately manage these patients. Silicone implants, autologous fat grafting and polymethyl methacrylate injections are among the most common procedures performed for these patients. There are several benefits for treating HIV-associated lipodystrophy beyond pure aesthetics. Changes in body morphology can be associated with psychological stress that can affect patients’ self-esteem and adherence to the medications. Therefore, plastic surgery procedures are highly indicated for patients presenting lipodystrophy caused by antiretroviral therapy.