We investigated the association between household food insecurity (HFI) and CD4% among 2-6 year old HIV+ outpatients (n=78) at the Botswana-Baylor Children's Clinical Center of Excellence in Gaborone, Botswana. HFI was assessed by a validated survey. CD4% data were abstracted from the medical record. We used multiple linear regression with CD4% (dependent variable), HFI (independent variable), and controlled for socio-demographic and clinical covariates. Multiple linear regression showed a significant main effect for HFI (beta=−0.6, 95% CI [−1.0, −0.1]) and child gender (beta=5.6, 95% CI [1.3, 9.8]). Alleviating food insecurity may improve pediatric HIV outcomes in Botswana and similar Sub-Saharan settings.