Over the past decade, HIV has been transformed from a terminal to chronic disease. Physical and occupational therapists are seeing increasing numbers of patients/clients who are aging with HIV. Nearly half of the adults with HIV experience mild to severe cognitive deficits, which can interfere with everyday functioning such as driving and medication adherence. Such cognitive deficits become more severe with increasing age. Given that nearly half of those with HIV will be 50 or older by 2015, physical and occupational therapists must explore strategies to improve or maintain cognitive functioning and/or mitigate for cognitive loss in this clinical population. In this review article, promising strategies to support healthy cognitive aging in HIV, such as psychostimulants and treatment of mental health issues, are discussed. Following this, some ineffective strategies such as acetylcholinesterase inhibitors are described. Finally, novel but unsupported strategies such as transcranial stimulation are examined. Implications for treatment and research are provided. © 2012 Informa Healthcare USA, Inc.