Background Although the HIV epidemic has mostly stabilized worldwide, the steady rise in the number of children orphaned by AIDS in sub-Saharan Africa currently accounts for an increase in the total population of orphans. The quality of alternative care will depend on the caregiver and the setting. Information on caregivers and the care settings for orphans could provide a basis for the formulation of appropriate strategic responses for their support. The aim of the article is to describe the demographic characteristics and alternative care profiles of orphans among children attending a pediatric antiretroviral treatment facility. Methods This was a cross-sectional study of consecutive children attending the antiretroviral therapy clinic of Ahmadu Bello University Teaching Hospital Zaria in Northern Nigeria. Demographic characteristics, HIV status, and caregiver information were obtained and recorded into a standardized structured proforma. Data were analyzed using SPSS software version 20 (IBM Corp., Armonk, New York, United States), and results presented as means, percentages, contingency tables and charts, with p values of Results Out of 441 children (mean age 73.5 ± 37.1 months), 53.3% were females, with 160 orphans and an orphan prevalence of 36.3%. Overall, 90 (56.3%) were paternal, 38 (23.8%) maternal, and 32 (20.0%) double orphans. Orphans were younger, with 59.4% also being HIV infected. Nearly half of these orphans (49.4%) were under the care of paternal relatives, with 39 (24.3%) being under the care of a grandmother. Conclusion Family kinship network constitutes a vital secondary alternative for orphan care next to care by surviving parents. The need for priority support directed at alternative caregivers cannot be overemphasized.