We performed a retrospective study using a cross-sectional design for each year from 1997 to 2008 to evaluate the trend in pneumonia rates among HIV-infected children in the highly active antiretroviral therapy (HAART) era in Spain. We found that rate of pneumonia decreased among HIV-Infected children in the highly active antiretroviral therapy era but still remained higher than in the general population. Non-AIDS-defining pneumonia remains a significant health problem for HIV-infected children.