Summary Risk factors for death in an HIV‐infected cohort in French Guiana were studied in 1374 patients between 1996 and 2005. Of these patients, 48.5% were male and 76% were immigrants. Covariates were measured at the time of consultation. There were 223 deaths. Addictions adjusted hazard ratio (HR)=13; 95% confidence interval (CI) 5.5–30.6; P< 0.001, age >60 years (HR=1.5; 95% CI 0.9–2.5; P=0.13), male gender (HR=1.5; 95% CI 1.03–2.5; P=0.03) and CD4 count <50 cells/μL (HR=9.1; 95% CI 5.1–16.3; P<0.001) were independently associated with death. These results suggest that strategies promoting early diagnosis and better follow‐up of addicted patients would have a significant impact on mortality.