Objective To understand the survival status and influencing factors of elderly patients with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) in Guigang City, and provide reference for the formulation of targeted prevention and control measures. Methods A retrospective cohort study was conducted to select HIV/AIDS patients aged ≥ 50 years from the comprehensive AIDS prevention and control information system as studied subjects, survival rate was calculated with table method, survival curve was drawn with Kaplan-Meier method, difference in survival time of different groups was compared with Log-Rank test, multivariate analysis was conducted by Cox proportional hazard model. Results Of the 5 397 studied subjects, 2 466 died, including 931 AIDS-related deaths. A total of 164 122.77 person-months were observed, HIV-related mortality was 5.67/1 000 person-months. The mean survival time was 129.680 months (95%CI:127.513-131.846), survival rates of these patients were 81%, 78%, 77%, and 76% at 12, 36, 60, and 96 months respectively after diagnosis. Multivariate Cox regression analysis showed that male, Han nationality, AIDS, sexual contact-based infection routes, low CD4⁺T cell level or undetected persons, not receiving antiretroviral therapy(ART) were all risk factors for survival time of elderly HIV/AIDS patients. Conclusion The survival rate of elderly people with HIV/AIDS in Guigang City is low, and survival time is affected by many factors, effective comprehensive prevention and control measures should be taken to reduce the risk of death and prolong the survival time.