Inducing cross-reactive broadly neutralizing antibody (bNAb) responses to HIV through vaccination remains an insurmountable challenge. T follicular helper cells (TFH) are fundamental for the development of antigen-specific antibody responses and therefore critical for anti-HIV vaccine design. Here we review recent studies supporting an intricate involvement of TFH in HIV pathogenesis and bNAb development in HIV infection. We also examine emerging data suggesting that TFH responses may be traceable in peripheral blood, and discuss the implications of these findings in the context of vaccine design and future research in TFH immunobiology.