OBJECTIVE: To identify risk factors of antiretroviral (ARV) regiments switching in children with Human Immunodeficiency Infection (HIV) infection.                                                           METHODS: This case control study involved HIV children less than 18 years old using ARV regiments from 2014 to 2018 at Dr.Soetomo Academic Hospital, Surabaya. Case defined as children with history of ARV regiments alteration to second line regiments. Data were collected from medical record with such case and control ratio was 1:1. Factors analyzed consist of nutritional status, weight loss, age, opportunistic infection, length of treatment, compliance. Nutritional status was assessed with WHO child growth standard and categorized into normal and under nutrition. Age was divided into less than one year-old(y.o), 1 to 5 y.o, and >5 y.o. Chi-square, Mann-Whitney, and regression test were used to identify risk factors. (P<0.005 considered significant)                                                                                                                            RESULTS: A total of 29 children, 15 cases, 14 control. Cause of ARV regiment switching were anemia (2/15), decreased CD4 level (3/15), drug side effect (3/15), drugs unavailable (2/15), and compliance problem (3/15), opportunistic infection (2/15). Factors associated with alteration of ARV regiment was weight loss (OR 7.2; 95%CI 1.4 to 38.3;P=0.016) and patient compliance (OR 7.2; 95%CI 1.4-38.3; P=0.016). Other analyzed factors such as nutritional status (OR 1.1; 95%CI 0.3 to 4.9; P=0.858), age (OR 4.8; 95%CI 0.8 to 30.2; P=0.109), opportunistic infection (OR 1.7; 95%CI 0.4 to 7.9; P=0.518), length of treatment  (OR 2.0; 95%CI 1.4 to 7.1; P=0.157) not associated with ARV regiments switching.                                                                               CONCLUSION: Changing ARV regiments rarely do by several reasons. In children with HIV infection, weight loss and compliance during therapy are factor associated with switching to second line ARV regiments.