Cardiometabolic problems in children with human immunodeficiency virus (HIV) infection have recently begun to emerge as distinct clinical problems that require monitoring and often intervention. The cardiometabolic issues that face HIV-infected children include high rates of unfavorable lipid profiles, insulin resistance, cardiovascular inflammation, and vascular stiffness as well as the phenotypic features of truncal adiposity and facial/extremity wasting. Children differ from adults in that many have been exposed to both HIV and antiretroviral therapies even before birth. The future risk of adverse cardiovascular outcomes is poorly defined yet warrants close tracking because a number of risk factors are present in early childhood. Preventive care and interventions that include surveillance of nutrition and body composition, dietary counseling, exercise programs, and drug therapy should be considered standard care for all HIV-infected children.