Evolution of CD4 T-Cell Count With Age in a Cohort of Young People Growing Up With Perinatally Acquired Human Immunodeficiency Virus
Authors: Castro Hannah , Sabin Caroline , Collins Intira Jeannie , Okhai Hajra , Schou Sandgaard Katrine , Prime Katia , Foster Caroline , Le Prevost Marthe , Crichton Siobhan , Klein Nigel , Judd Ali ,   Collaborative HIV Paediatric Study, Lyall Hermione , Bamford Alasdair , Butler Karina , Doerholt Katja , Doherty Conor , Foster Caroline , Kenny Julia , Klein Nigel , Letting Gillian , McMaster Paddy , Murau Fungai , Nsangi Edith , Prime Katia , Riordan Andrew , Shackley Fiona , Shingadia Delane , Storey Sharon , Tudor-Williams Gareth , Turkova Anna , Welch Steve , Collins Intira Jeannie , Cook Claire , Crichton Siobhan , Dobson Donna , Fairbrother Keith , Gibb Diana M , Judd Ali , Le Prevost Marthe , Van Looy Nadine , Peters Helen , Francis Kate , Thorne Claire , Thrasyvoulou L , Welch S , Fidler K , Bernatoniene J , Manyika F , Sharpe G , Subramaniam B , Hague R , Price V , Flynn J , Cardoso A , Abou–Rayyah M , Klein N , Bamford A , Shingadia D , Grant K , Yeadon S , Segal S , Hawkins S , Dowie M , Bandi S , Percival E , Eisenhut M , Duncan K , Anguvaa L , Wren L , Flood T , Pickering A , McMaster P , Murphy C , Daniels J , Lees Y , Thompson F , Williams A , Williams B , Pope S , Libeschutz S , Cliffe L , Southall S , Freeman A , Freeman H , Christie S , Gordon A , Jones L , Brown L , Greenberg M , Benson C , Riordan A , Ibberson L , Shackley F , Patel S , Hancock J , Doerholt K , Prime K , Sharland M , Storey S , Lyall E G H , Foster C , Seery P , Tudor-Williams G , Kirkhope N , Raghunanan S , Kenny Dr J , Callaghan A , Bridgwood A , McMaster P , Evans J , Blake E , Yannoulias A ,   UK Collaborative HIV Cohort Study, Ainsworth Jonathan , Allan Sris , Anderson Jane , Apoola Ade , Chadwick David , Churchill Duncan , Delpech Valerie , Dunn David , Fairley Ian , Fox Ashini , Gilson Richard , Gompels Mark , Hay Phillip , Hembrom Rajesh , Hill Teresa , Johnson Margaret , Jose Sophie , Kegg Stephen , Leen Clifford , Mital Dushyant , Nelson Mark , Okhai Hajra , Orkin Chloe , Palfreeman Adrian , Phillips Andrew , Pillay Deenan , Price Ashley , Post Frank , Pritchard Jillian , Sabin Caroline , Schwenk Achim , Tariq Anjum , Trevelion Roy , Ustianowski Andy , Walsh John , Dunn David , Hill Teresa , Okhai Hajra , Phillips Andrew , Sabin Caroline , van Looy Nadine , Fairbrother Keith , Orkin Chloe , Lynch Janet , Hand James , Churchill Duncan , Tilbury Stuart , Youssef Elaney , Churchill Duncan , Nelson Mark , Daly Richard , Asboe David , Mandalia Sundhiya , Anderson Jane , Munshi Sajid , Post Frank , Adefisan Ade , Taylor Chris , Gleisner Zachary , Ibrahim Fowzia , Campbell Lucy , Chadwick David , Baillie Kirsty , Gilson Richard , Williams Ian , Ainsworth Jonathan , Schwenk Achim , Miller Sheila , Wood Chris , Johnson Margaret , Youle Mike , Lampe Fiona , Smith Colette , Tsintas Rob , Chaloner Clinton , Sabin Caroline , Phillips Andrew , Hill Teresa , Okhai Hajra , Walsh John , Mackie Nicky , Winston Alan , Weber Jonathan , Ramzan Farhan , Carder Mark , Leen Clifford , Kerr Andrew , Wilks David , Morris Sheila , Gompels Mark , Allan Sue , Palfreeman Adrian , Lewszuk Adam , Kegg Stephen , Ogunbiyi Victoria , Mitchell Sue , Hay Phillip , Hunt Christopher , Okolo Olanike , Watt Benjamin , Fairley Ian , Russell-Sharpe Sarah , Fagbayimu Olatunde , Allan Sris , Brain Debra , Tariq Anjum , Radford Liz , Milgate Sarah , Pritchard Jillian , Cumming Shirley , Atkinson Claire , Mital Dushyant , Rose Annie , Smith Jeanette , Ustianowski Andy , Murphy Cynthia , Gunder Ilise , Fox Ashini , Gees Howard , Squires Gemma , Anderson Laura , Hembrom Rajesh , Mansfield Serena , Tomlinson Lee , LeHegerat Christine , Box Roberta , Hatton Tom , Herbert Doreen , Price Ashley , McVittie Ian , Murtha Victoria , Shewan Laura , Apoola Ade , Connan Zak , Gregory Luke , Holding Kathleen , Chester Victoria , Mistry Trusha , Gatford Catherine , Delpech Valerie , Trevelion Roy 
Published: October 2023

Abstract

Background
Recent studies have shown a decrease in CD4 count during adolescence in young people with perinatally acquired human immunodeficiency virus (HIV, PHIV).

Methods
Young people with PHIV in the United Kingdom, followed in the Collaborative HIV Paediatric Study who started antiretroviral therapy (ART) from 2000 onward were included. Changes in CD4 count over time from age 10 to 20 years were analyzed using mixed-effects models, and were compared to published CD4 data for the gerneral population. Potential predictors were examined and included demographics, age at ART start, nadir CD4 z score (age-adjusted) in childhood, and time-updated viral load.

Results
Of 1258 young people with PHIV included, 669 (53%) were female, median age at ART initiation was 8.3 years, and the median nadir CD4 z score was −4.0. Mean CD4 count was higher in young people with PHIV who started ART before age 10 years and had a nadir CD4 z score ≥−4; these young people with PHIV had a decline in CD4 count after age 10 that was comparable to that of the general population. Mean CD4 count was lower in young people with PHIV who had started ART before age 10 and had a nadir CD4 z score &lt;−4; for this group, the decline in CD4 count after age 10 was steeper over time.

Conclusions
In children, in addition to starting ART at an early age, optimizing ART to maintain a higher CD4 z score during childhood may be important to maximizing immune reconstitution later in life.