The objective of this project was to study the functional status of HIV-infected persons seen in an ambulatory care setting. We reviewed baseline clinical and demographic data on patients with HIV infection presenting for care between December 1988 and May 1991 at the HIV Clinic of the Johns Hopkins Hospital, an urban, primary Care institution. Functional status was assessed at baseline in a comprehensive psychosocial assessment. Patients were asked to report on their ability to perform six activities of daily living (ADL) and nine instrumental activities of daily living (IADL). The main put-come measures were dependency in one or more ADL and death as ascertained by review of clinic death records and Maryland State Death Registries. All 728 patients had assessments of functional status. Of these, 18% reported dependencies in one or more activity, with most of these (14%) reporting dependencies in IADLs only. Dependencies were more common in persons with an AIDS diagnosis (32% vs. 15%, p < 0.001). The majority of the dependencies reported by AIDS patients were also in IADLs. Mean CD4 counts were lower for persons reporting dependencies than for those who reported no dependencies (p = 0.02). No independent associations were found between functional limitation and demographic variables. The risk of death was greater in patients with dependencies than in patients with no dependencies, even when adjusting for CD4 count and AIDS diagnosis (O.R. = 2.32, p = 0.001). Proportional hazards modeling showed that mortality was independently associated with an AIDS diagnosis (hazard ratio 1.82, p = 0.05), CD4 count <200/mm3(hazard ratio 2.37, p = 0.01), and CD4 <200/mm3and functional dependency (hazard ratio 3.45, p = 0.056). The majority of patients is this population had no functional dependencies at their initial visit, including patients with AIDS. Those patients who did have dependencies were more likely to need assistance with activities necessary for independent living, such as cooking or shopping, rather than for self care. For patients with advanced HIV disease, functional dependencies are associated with a greater risk of death.