Background: This study assessed the predictors of self-esteem among Adolescents Living with HIV (ALHIV) in Ghana seeking healthcare at Komfo Anokye Teaching Hospital. Methods: A cross-sectional study was employed in sampling 139 adolescents using a purposive sampling technique. Rosenberg’s rating scale was used in assessing the self-esteem of the participants. Results: A total of 139 adolescents made up of 78 (56.12%) females and 61 (43.88%) males were recruited. Low self-esteem was reported among 66 (47.00%) of the adolescents. Adolescents aged 17-19 years (aOR = 2.97, 95%CI = 1.34-6.56, p = 0.007) were significantly associated with low self-esteem. Conclusion: The occurrence of low self-esteem among ALHIV was high and more pronounced among those in age cohorts of 17 to 19 years. Social support interventions designed which includes psychosocial support, life skills training, and avenue for discussing sexual and reproductive health matters could improve self-esteem.