One of my closest friends was diagnosed with HIV in 1986. He almost died in 1994 and was saved by a drug trial w/ a protease inh and two other meds. Lately, he has some behavioral changes and I'm concerned. He is forgetful and he mixes his words up IE if he wants a book on the table he might say get me the sandwich on the table. Or open the light instead of turn on the light. If it was not happening on a regular basis I'd brush it off but it happens all of the time and I'm worried. He has been on many different cocktails over the years. His relationship w/ his partner is good and his family is very supportive. He has quite a few very loyal and protective friends. Should I tell him he might want to see a psych MD and if so how can I say this tactfully so I don't hurt his feelings?

It's perfectly acceptable to talk with your friend about what you've observed. You can say in a kind and caring way that you've noticed some changes in his memory and maybe he should have this evaluated to see it's significant or not. You don't do your friend a favor by letting it go. Although it may be upsetting for your friend to hear this, it is better than letting it go. Some causes of memory impairment can be treated if caught early enough. Furthermore, if he has a progressive memory impairment that is worsening, it is better for him to know early, while he still has the capacity to make decisions about how he wants to handle important matters, and before he becomes too impaired and lacks the capacity to do this himself.