Background: There is an evidence gap regarding the relationship between HIV exposure, body composition (and the quality thereof) and preterm infants. Aim: This study determined the body composition of HIV-exposed, preterm very low-birthweight (VLBW) and extremely low-birthweight (ELBW) infants and to assess the effect of maternal HAART duration on the body composition of this vulnerable population. Methods: A descriptive cross-sectional study was conducted. HIV-exposed and -unexposed preterm infants (Results: Thirty preterm infants (27%) were HIV-exposed. HIV-exposed infants had significantly (=0.01) lower gestational ages than HIV-unexposed infants (25–28 weeks). HIV-exposed infants had significantly lower measurements on day 21 and day 28 for triceps skinfold (TSF) (2.5 mm vs 2.7 mm, = 0.02 and 2.6 mm vs 2.9 mm, Conclusion: Mothers receiving HAART could have increased risk of preterm delivery, and the duration of maternal HAART affects postnatal body composition of their infants. Body composition differs between HIV-exposed and HIV-unexposed preterm infants.