The wider availability of highly active antiretroviral therapy has resulted in a concomitant increase in adults aging with HIV and the persistence of milder forms of neuropsychological impairment in this cohort. This study investigated the differences in neuropsychological functioning between a group of HIV+ adults and older adults and an HIV– matched control group. Participants from a semi-urban community clinic volunteered to participate in the study. The performance of 50 participants (33 HIV+ and 17 HIV–) who met the inclusion criteria were compared on the following measures: Dementia Rating Scale-2, the Stroop Color and Word Test, the Symbol Digits Modalities Test, and the Delis–Kaplan Executive Function System Trail Making Test. The results indicated that the HIV+ in comparison with the HIV– negative group had poorer performance profiles in global cognitive functioning, memory, executive functioning, visuoconstruction ability, psychomotor functioning, and processing speed. The findings suggest that further research in South Africa will contribute to a better understanding of the neuropsychological profiles of adults aging with HIV and inform intervention strategies specific to addressing the mental healthcare needs of this subgroup.