The Beck Depression Inventory, Karnofsky Scale of Physical Performance, and a visual-analogue scale to assess subjective distress were administered to 32 HIV-infected medical inpatients shortly after admission and prior to discharge. Twenty-eight percent of subjects had severe depressive symptoms on admission. Most of these subjects remained in the severe range of depressive symptoms at discharge, despite physical improvement comparable to subjects with lower levels of depressive symptoms. In contrast, subjects with moderate depressive symptoms on admission showed a significant decrease in depressive symptoms at discharge. The results suggest that the etiology and management of depressive symptoms in HIV-infected medical inpatients may differ depending on the initial severity of depressive symptoms.