Children and adolescents living with human immunodeficiency virus (HIV) represent a population that requires a unique approach to HIV care. Prevention, testing, initiation of antiretroviral therapy (ART), and retention and engagement in care are critical steps. Each step requires providers to address age-specific barriers, so that successful and prolonged viral suppression can occur. Adherence to ART, disclosure of HIV-positive status, and stigma are examples of struggles faced by youth, their families, and health care providers. A multifaceted approach and thoughtful transitions of care are needed, but with sustained ART, youth living with HIV can survive and thrive with the expectation of a normal lifespan.