Objective: Deficits in initiation, the ability to mobilize cognitive resources, may underlie both executive functioning and processing speed impairments frequently observed in HIV-associated neurocognitive disorders (HAND). We therefore explored the utility of a measure of cognitive initiation (FAS15) as a predictor of cognitive decline from normal to mild neurocognitive disorder (MND) over time. FAS15 is the percentage of total correct responses on an FAS letter fluency task given in the first 15 second epoch. Method: A cognitively normal HIV+ group that remained cognitively normal at average one-year follow-up (n = 19) was compared to a demographically similar HIV+ group that converted from cognitively normal to MND at one-year average follow-up (n = 21) on baseline measures of FAS15 and FAS total correct. Results: The two groups did not differ on demographic or disease variables. After controlling for age, WRAT-3 reading score, and CD4 count, binary logistic regression identified baseline FAS15 as a significant predictor of conversion from cognitively normal to MND over the course of a year, χ2(4) = 6.37, p = .012. However, FAS total correct did not emerge as a significant predictor of cognitive decline, χ2(4) = 1.48, p > .05. Age, reading score, viral load, and CD4 count did not independently predict group conversion. Conclusion(s): The findings suggest that FAS15 (cognitive initiation), but not FAS total (a measure of executive functioning), may serve as an early predictor of conversion from cognitively normal to MND in those with HIV. These findings require replication in a larger sample.