Background: Estimates of the prevalence of lifetime suicidal ideation and attempt, and risks for new-onset suicidality, among HIV-infected (HIV+) individuals are not widely available in the era of modern combined antiretroviral treatment (cART). Method: Participants (n = 1560) were evaluated with a comprehensive battery of tests that included the depression and substance use modules of the Composite International Diagnostic Interview (CIDI) and the Beck Depression Inventory-II (BDI-II) as part of a large prospective cohort study at six U.S. academic medical centers. Participants with possible lifetime depression (n = 981) were classified into five categories: 1) no thoughts of death or suicide (n = 352); 2) thoughts of death (n = 224); 3) thoughts of suicide (n = 99); 4) made a suicide plan (n = 102); and 5) attempted suicide (n = 204). Results: Twenty-six percent (405/1560) of participants reported lifetime suicidal ideation and 13% (204/1560) reported lifetime suicide attempt. Participants who reported suicidal thoughts or plans, or attempted suicide, reported higher scores on the BDI-II (p < 0.0001), and higher rates of current major depressive disorder (p = 0.01), than those who did not. Attempters reported higher rates of lifetime substance abuse (p = 0.02) and current use of psychotropic medications (p = 0.01) than non-attempters. Limitations: Study assessments focused on lifetime, rather than current, suicide. Data was not collected on the timing of ideation or attempt, frequency, or nature of suicide attempt. Conclusions: High rates of lifetime suicidal ideation and attempt, and the relationship of past report with current depressed mood, suggest that mood disruption is still prevalent in HIV. Findings emphasize the importance of properly diagnosing and treating psychiatric comorbidities among HIV persons in the cART era. © 2011 Elsevier B.V. All rights reserved.