Pediatric acquired immunodeficiency syndrome (AIDS) and human immunodeficiency virus (HIV) infection will soon be the primary infectious cause of perinatally acquired developmental disabilities in the United States. HIV encephalopathy and a variety of opportunistic infections, neoplasms, and vascular changes associated with pediatric HIV infection create a high probability of neuropsychological impairment among preschool and school-age children infected perinatally. Although the use of antiretrovirals may moderate some of the functional difficulties faced by these children, specific neuropathological and neuropsychological deficits are likely to remain. Treatments that prevent the central nervous system (CNS) effects of HIV have yet to be identified. As the epidemic progresses among women of child-bearing age, well-controlled developmental studies are needed to further clarify the relationship between HIV and child development, and to aid professionals in developing appropriate, school-based educational plans.