Treatment of HIV infection with highly active antiretroviral therapy (HAART) confers survival and quality of life benefits. However, these significant benefits are at the cost of metabolic complications with associated increased risk of type 2 diabetes and cardiovascular disease. These chronic diseases add complexity to the standards of care in HIV infection and much remains unknown about the natural histories of diabetes and hyperlipidemia in this setting. This review examines recent research findings in diabetes and hyperlipidemia in HIV infection, juxtaposed on our prior understanding of these diseases. It also reviews the current evidence base and clinical guidelines for diabetes and lipid management and cardiometabolic prevention in HIV-infected HAART recipients.