Declines in metacognitive ability occur more with aging and HIV such that some people aging with HIV may be even less able to report accurately on the status of their cognitive functioning. This is problematic because clinicians and allied health professionals rely on clients' self-reports of cognition to help judge if they are developing cognitive impairments. Such self-reports of cognition may be moderated by mood disturbance, histories of alcoholism or drug abuse, or even limited educational achievement. In this review, implications of this phenomenon and suggestions for researching this topic and assessing at-risk clients are posited. © Perceptual and Motor Skills 2006.