The epidemiologic, neuropsychiatric, and medical data on AIDS and HIV infection that are relevant to state psychiatric facilities are reviewed. The epidemiologic data suggest that a larger than expected number of AIDS patients may be seen in these facilities. Patients who are severely disturbed and psychotic may present to state hospitals with HIV encephalopathy. In patients who are chronically and severely ill, physical symptoms, including oral and cutaneous conditions, the HIV wasting syndrome, and lymphadenopathy, may provide early dues to HIV infection. The early neuropsychiatric and medical findings in HIV infection are discussed, and a clinical case is presented.