Purpose: Sedentary behavior (SB) has been shown to be associated with unhealthy outcomes in children, and it is not clear whether children living with human immunodeficiency virus (HIV) engage in different patterns of SB compared with healthy children. This cross-sectional study aimed to compare patterns of SB between children living with HIV and a healthy control group. Methods: A group of children with HIV and a paired control group wore accelerometers for 1 week and answered a questionnaire with items related to television viewing habits and computer usage. Accelerometer-derived and self-reported SB were compared between children living with HIV and controls and between treatment-based and viral load subgroups. Results: A total of 130 children (of which 53% are girls with a mean age of 12.1 y) participated in the study with 65 in each group. Children in the control group exhibited significantly more objectively measured SB daily when compared with the HIV group (515 vs 490 min/d, respectively), but no differences were found between the treatment-based and viral load subgroups. Children with HIV watched more television on weekdays, compared with the control group (P < .05). No other differences were found in comparisons of self-reported SB between the control and HIV and the treatment-based or viral load subgroups. Conclusion: Children living with HIV spend less time being sedentary than those in the healthy control group. Future studies are important for clarifying the causes and consequences of these differences.