Diarrhoeal diseases continue to play a major role in the lives of HIV-positive people, impacting negatively on quality of life and causing significant morbidity and mortality. Within the global HIV pandemic, there are distinct geographical variations in the aetiology of chronic diarrhoea and the strategies towards its diagnosis and management. This article aims to highlight the contemporary approach to chronic diarrhoea in HIV-positive people, expand upon the myriad agents responsible for this presentation, and explore present and future therapeutic and management options.