African HIV-infected children benefit from access to antiretroviral treatments but little is known about their adherence. A cross-sectional assessment of adherence to highly active antiretroviral therapy was conducted among a group of children recruited in an observational cohort in Abidjan, Côte d'Ivoire. Adherence was determined by a 1-month recall by child or caregiver, with full adherence signifying no interruptions in the prior month. One-third reported less than full adherence. Undetectable viral load was associated with full adherence in a subset of children with a P value <10% (P = 0.098). As compared with children with full adherence, those with less than full adherence were significantly older and more likely to be taking efavirenz. These findings underscore the necessity of assessing and supporting children's adherence routinely in AIDS care institutions.