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With recent advances in the treatment of human immunodeficiency virus (HIV), renal transplantation is no longer considered a contraindication in properly selected HIV-positive patients. However, while doing transplant in an HIV-positive patient, one needs to keep in mind the interaction between HIV drugs and immunosuppressive drugs. Further, doing an ABO-incompatible (ABOi) transplant could be a challenge due to higher immunosuppression that can result from the desensitization, exacerbating HIV-related immune dysfunction. We report a case of successful living-related donor ABOi kidney transplant in an HIV-positive patient.