HIV cognitive impairments are a common occurrence. Although some of the etiologies of such cognitive impairments are understood, some of the causes are not always straightforward because adults with HIV represent a very heterogenous population. Unfortunately, many of the studies that investigate cognition in this population rely on convenience samples of HIV-positive adults who may lack cognitive stimulation due to poor education or unemployment, both of which can promote negative neuroplasticity. By the same token, other adults with HIV may be cognitively stimulated by their work, educational pursuits, and intellectual interests which may promote positive neuroplasticity which may be protective against cognitive impairments. Implications for how this impacts research as well as prevention and intervention of cognitive impairments are posited. © Med Sci Monit, 2010.