Previous studies indicate that older individuals with AIDS are at increased risk for morbidity and death. The purpose of this study was to examine the clinical manifestations of male patients older than 45 when they entered HIV care and the survival of the older men who had AIDS. A historical, nonconcurrent cohort study of HIV-infected men (n = 2583) enrolled in the HIV outpatient program of the Medical Center of Louisiana in New Orleans as of January 2000 was conducted. Age older than 50, wasting syndrome, cancer, and neutropenia were predictive of death. These findings suggest the need to closely monitor older men with AIDS who have these conditions and provide appropriate therapies. The significantly higher proportions of older men with AIDS at study entry and no reported risk factor also indicates the need to target prevention and education efforts at older individuals.