Purpose: To assess and compare the oral manifestations of HIV-infected paediatric patients undergoing ART (anti-retroviral therapy) and those not undergoing ART. Methods: A cross-sectional study was conducted amongst the 5-12 years old, HIV positive children (receiving and not receiving ART) registered at Nireekshana ART centre, Hyderabad and HIV negative children enrolled in a nearby school. HIV-related oral lesions were diagnosed according to WHO criteria. Information on age, gender, place of residence (urban/rural), socio-economic status, duration of HIV infection, duration of ART therapy, use of traditional medicine, presence of HIV-related systemic disease was recorded. CD4+ cell count was also determined for each subject. Chi-square test, stepwise multiple linear and logistic regression were used for statistical analysis. For all tests, confidence interval and p value were set at 95 % and p ≤ 0.05, respectively. Results: Twelve percent and 21.3 % of the study participants were on short-term and long-term ART (Group I), respectively. A greater proportion of HIV patients receiving treatment had CD4+ cell counts of more than 750 cells/mm3. Nearly 81.3 % of HIV patients receiving long-term therapy did not have any oral lesions. Around half of the participants not receiving treatment suffered from HIV-related oral lesions. The best predictors for presence of oral lesions were socio-economic status, group (ART treatment), duration of HIV infection and CD4+ cell count. Conclusion: The results of the present study demonstrated that ART proved to be effective in reducing the prevalence of HIV-related oral lesions. © 2013 European Academy of Paediatric Dentistry.