Introduction <p>Despite major advances in antiretroviral therapy, HIV infection remains a significant global public health challenge. HIV can directly affect the kidneys, leading to HIV-associated nephropathy in children, a condition characterized by proteinuria, elevated serum creatinine, and kidney enlargement. HIV-associated nephropathy is a serious complication that may progress to kidney failure and death.</p> Objective <p>To estimate the prevalence of HIV-associated nephropathy in children.</p> Methods <p>We searched PubMed, Embase, LILACS, SciELO, and Web of Science for relevant studies. Searches used the terms “AIDS-associated nephropathy” AND “child.”</p> Results <p>A total of 1,181 records were identified, of which 10 studies (n = 1,136 children living with HIV) met inclusion criteria. Most included studies were conducted before widespread ART availability and used proteinuria as a proxy for HIV-associated nephropathy. The pooled prevalence of HIV-associated nephropathy was 17% (95% CI, 8%–31%; I² = 93%, <i>p</i> &lt; 0.01). Subgroup analysis showed marked geographic variation, with a prevalence of 29% (95% CI, 22%–38%) in Africa and 8% (95% CI, 3%–20%) in North America. By sex, 59% (95% CI, 49%–69%) of male children developed HIV-associated nephropathy compared with 41% (95% CI, 31%–51%) of female children. Boys were significantly more likely to develop HIV-associated nephropathy (<i>p</i> = 0.02). The mortality rate among affected children was 53% (95% CI, 40%–56%). Key risk factors included lack of antiretroviral therapy and the presence of AIDS.</p> Conclusion <p>HIV-associated nephropathy was historically a common and life-threatening complication among children living with HIV. However, the available evidence is largely based on studies conducted more than a decade ago and often relied on proteinuria rather than biopsy-confirmed diagnosis.</p>