Background Previous studies have shown that men with HIV and germ cell cancer (HIV‐GCC) have inferior overall survival (OS) in comparison with their HIV‐negative counterparts. However, little information is available on treatments and outcomes of HIV‐GCC in the era of combination antiretroviral therapy (cART). Methods This study examined men living with HIV who were 18 years old or older and had a diagnosis of histologically proven germ cell cancer (GCC). The primary outcomes were OS and progression‐free survival (PFS). Results Data for 89 men with a total of 92 HIV‐GCCs (2 synchronous GCCs and 1 metachronous bilateral GCC) were analyzed; among them were 64 seminomas (70%) and 28 nonseminomas (30%). The median age was 36 years, the median CD4 T‐cell count at GCC diagnosis was 420 cells/µL, and 77% of the patients on cART had an HIV RNA load < 500 copies/mL. Stage I disease was found in 44 of 79 gonadal GCCs (56%). Among 45 cases with primary disseminated GCC, 78%, 18%, and 4% were assigned to the good‐, intermediate‐, and poor‐prognosis groups, respectively, of the International Germ Cell Cancer Collaborative Group. Relapses occurred in 14 patients. Overall, 12 of 89 patients (13%) died. The causes of death were refractory GCC (n = 5), an AIDS‐defining illness (n = 3), and other causes (n = 4). After a median follow‐up of 6.5 years, the 5‐ and 10‐year PFS rates were 81% and 73%, respectively, and the 5‐ and 10‐year OS rates were 91% and 85%, respectively. Conclusions The 5‐ and 10‐year PFS and OS rates of men with HIV‐GCC were similar to those reported for men with HIV‐negative GCC. Patients with HIV‐GCC should be managed identically to HIV‐negative patients. Lay Summary Men living with HIV are at increased risk for germ cell cancer (GCC). Previous studies have shown that the survival of men with HIV‐associated germ cell cancer (HIV‐GCC) is poorer than the survival of their HIV‐negative counterparts. This study examined the characteristics, treatments, and outcomes of 89 men with HIV‐GCC in the era of effective combination antiretroviral therapies. The long‐term outcomes of men with HIV‐GCC were similar to those reported for men with HIV‐negative GCC. Patients with HIV‐GCC should be managed identically to HIV‐negative patients. In this study of 89 men with HIV and germ cell cancer, the 5‐year progression‐free and overall survival rates are 81% and 91%, respectively. The long‐term outcomes of men with HIV‐associated germ cell cancer are similar to those reported for men with HIV‐negative germ cell cancer.