Antibody-dependent cellular cytotoxicity (ADCC) is of considerable interest as an immune response that may facilitate control of HIV infection. We studied ADCC responses prospectively in a cohort of 79 HIV+ subjects followed for a mean of 2.3 years without antiretroviral therapy. We used a novel assay of the ability of ADCC to activate NK cells, either from the same HIV+ subject or a healthy blood donor. We found ADCC responses to either gp140 Env protein or HIV peptide pools were common in HIV+ subjects when NK cells from the HIV+ subject were used, but did not correlate with markers of HIV disease progression. In contrast, ADCC responses to whole gp140 Env protein were strongly associated with a slower decline in CD4 T cell loss when healthy donor NK cells were used as effectors. Our data had implications for induction of the most effective ADCC responses by HIV vaccines.