With an incidence between 1:100,000 and 1:250,000, spondylodiscitis is rare, but is increasingly reported due to longer life expectancy, risk factors, and comorbidities, with HIV+ patients being at greater risk. We reviewed the literature on the diagnostic tools, and on the benefits and drawbacks of different treatments of spondylodiscitis in HIV- positive patients. We discuss basic strategies and indications for surgery. Recently, the trend was toward early mobilization of patients after surgical treatment. Modern surgical and antibiotic treatment can prevent a recurrence in these patients. The decision to opt for conservative or surgical treatment should be made depending on the extent of infection and the responsible pathogen, without regard to HIV. However, these patients should be treated in a specialized hospital by an experienced interdisciplinary team of consultants.