I have a good friend who has been HIV+ for 12 or more years and refuses to get treatment. he has always had mood swings and been suspicious of others but has lately become very delusional and paranoid. He does not seem to have dementia in the sense of memory loss, but his thinking seems muddled. He claims he does not have AIDS but has been treated for many many skin cancers, which seems to me could be construed as opportunistic infections. Is this a possible sign of aids related dementia, even if he seems to have an intact memory? he becomes more paranoid when I try to convince him to see a doctor. He tells virtually no one about his condition. Thank you.

Psychosis is one manifestation of HIV-associated dementia. It tends to be more common in people who have a history of prior psychiatric disorder or drug abuse (especially amphetamines and other stimulants). Psychosis is sometimes also a sign of very advanced AIDS, and your friend should seek treatment immediately. If he is refusing to see a doctor now, then his judgment is impaired due to the psychosis. You can try to get psychiatric help to treat the psychosis. That may be the only way to get him to agree to treatment for the HIV.