Global Trends in CD4 Measurement and Immunosuppression at ART Initiation Among Children With HIV

Pediatr Infect Dis J. 2025 Apr 4;44(9):873-875. doi: 10.1097/INF.0000000000004819.

Abstract

Eligibility for antiretroviral therapy is no longer based on immune criteria. In a global cohort of 97,453 children, between 2005 and 2021, we observed large declines in CD4 measurement, from 51% to 12% among <5 seconds, and from 74% to 20% among those 5-14 years of age. Lack of CD4 testing may negatively affect clinical care and surveillance of severe immune suppression.

Keywords: CD4 cell count; advanced HIV disease; antiretroviral therapy; pediatric HIV; severe immune suppression.

MeSH terms

  • Adolescent
  • Anti-HIV Agents* / therapeutic use
  • CD4 Lymphocyte Count / trends
  • Child
  • Child, Preschool
  • Cohort Studies
  • Female
  • Global Health
  • HIV Infections* / drug therapy
  • HIV Infections* / epidemiology
  • HIV Infections* / immunology
  • Humans
  • Infant
  • Male

Substances

  • Anti-HIV Agents