Human immunodeficiency virus type 1 (HIV-1) is the main pathogen of acquired immune deficiency syndrome (AIDS), which can cause a variety of opportunistic infections,tumorigenesis, and eventually death. Studies have indicated that exosomes play a crucial role during the progression of persistent HIV-1 infection, acting as key mediators of intercellular communication. This review focuses on the involvement of exosomes derived from dendritic cells,T cells, and semen in HIV-1 infection. It also elucidates the role of blood-derived exosome contents, specifically microRNAs (miRNAs),which not only serve as biomarkers but also participate in the HIV-1 infection process. Furthermore,blood-derived exosomes mediate HIV-1-associated chronic inflammation, thereby contributing to the infection process. This review also discusses the mechanisms by which brain-derived exosomes induce HIV-1-associated neurocognitive disorders, as well as their therapeutic implications, and the role of T cell-derived exosomes in promoting the occurrence and development of HIV-1-associated malignancies. This article elaborates on the mechanisms by which exosomes from diverse origins contribute to the occurrence, development, and outcomes of HIV-1 infection, with the aim of providing new insights for early screening and therapeutic intervention of HIV-1 infection.