As adults age with Human Immunodeficiency Virus (HIV) disease, they may be particularly vulnerable for developing neuropsychological impairments. In this pilot study, 50 HIV-positive and 50 HIV-negative adults were assessed on a variety of cognitive, affective, and aging measures. The HIV-positive group rated their cognitive ability as poorer compared with their HIV-negative counterparts. In fact, those who reported such cognitive complaints performed worse on several neuropsychological measures. However, many of these complaints may be mediated by psychosocial factors such as depression and stigma. Finally, the HIV-positive group also perceived that they were not aging as well. Given that cognitive complaints correspond to neuropsychological performance, therapists should pay special attention to clients' reports of decreased cognitive vitality as this could indicate the development of neuropsychological presentation. Implications for prevention, cognitive remediation, and successful aging are posited. © 2005 by The Haworth Press, Inc. All rights reserved.