This study was undertaken to assess the nutritional status and growth pattern of HIV positive children receiving and not-receiving anti- retroviral treatment in Dar es salaam. Specific objectives to assess the nutritional status and growth pattern of children receiving and not receiving ARV treatment. Anthropometric measurements were taken which were height and weight. Biomarkers of HIV i.e. CD4 count were taken at baseline and at the end of the study. The study revealed that HIV positive children receiving ARV were growing slightly better (p > 0.05) in WAZ, HAZ and WHZ than their counterparts not receiving ARV. The study further revealed that, HIV + children who were receiving ARVs had slightly higher (p > 0.05) CD4 and CD4:CD8 ratio compared to their peers not receiving ARVs. It showed that ARVs had small effect on growth of both boys and girls who were taking ARVs and multivitamin combinations. HIV+ children receiving not receiving ARVs followed similar patterns of growth, although the children receiving ARVs had slightly higher z-scores of weight for age and weight for height. HIV infection is a strong risk factor for mortality among children in Tanzania. It was concluded from this study that, although ARVs appeared to have beneficial effect on weight gain, the effect was insignificant. Since all children were receiving multivitamin supplementation, a good nutrition would produce the same effect even if ARVs are not provided. Provision of good nutrition, including supplementation with multivitamin and minerals in a viable, safe and practical approach in the management of HIV+ children. Due to side effects associated with the use of ARVs which are nevertheless designed for adults use of dietary approach is highly recommended for the HIV+ children. This study showed that, use of dietary approach is just as good as using ARVs.