Using grounded theory methods, open-ended interviews were conducted with persons diagnosed with HIV disease to explore and describe how they adjust to living with their disease in relation to their health-related quality of life over the illness trajectory. A substantive theory was generated that describes the process of learning to live with the unpredictability of the disease to maintain life quality. "Archieving a Balance," the core process identified, describes the psychosocial adjustment process of persons with HIV disease from the time of diagnosis to their current circumstances. The process involves balancing the requirements of living with the progression of the disease with the desire to maintain control over one's life, to the extent possible, to maintain life quality. Achieving a Balance is described within the illness trajectory with four major stages--Disintegrating, Renormalizing, Coming to Terms, and Creating Meaning. Characteristics within these stages, which enhance or diminish life quality are described, and a definition of health-related quality, of life is proposed. Interventions are recommended for nurses who care for persons living with HIV disease.