Medical advancements in the treatment of HIV continue to return ever more impressive medical results; increasing life expectancy and reducing negative symptoms (either disease-related or medically-induced). Physical wellness, however, is only one of the many facets of human life. It has been 5 years since Lazarus et al proposed we should be looking towards a fourth 90—good health-related quality of life (QoL)—yet little has been done to take up this task within a coherent approach. We suggest that one of the barriers to this is a lack of definition about what we mean by ‘good health-related quality of life’ (HRQoL) for people living with HIV. This article considers existing definitions of this, and related terms, and the difficulties in finding a universal definition. It goes on to suggest a way to a conceptual HRQoL in people living with HIV based on the biopsychosocial model. It is proposed that by doing it this way, practitioners can assess HRQoL in a comprehensive way, and focus on the things that matter to the individual.