Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 May;26(5):800-812.
doi: 10.1111/hiv.70015. Epub 2025 Mar 25.

Trends of severe HIV disease and mortality among children in rural Tanzania

L S Moshi  1   2 , J Okuma  3   4 , E Luoga  1   2 , A V Kalinjuma  1   5 , G J Mollel  1   2 , G Sigalla  1   2 , L Wilson  1 , E Dotto  1 , T Glass  3   4 , F Vanobberghen  3   4 , M Weisser  1   3   6 ; KIULARCO study group
Collaborators, Affiliations

Trends of severe HIV disease and mortality among children in rural Tanzania

L S Moshi et al. HIV Med. 2025 May.

Abstract

Objective: To assess trends of severe HIV disease (SHD) and mortality/loss to follow-up (LTFU) among children living with HIV in rural Tanzania.

Methods: Among children aged 0-14 years living with HIV enrolled in the prospective Kilombero & Ulanga Antiretroviral Cohort in January 2005-December 2023, we determined WHO-defined SHD prevalences at enrolment, mortality/LTFU incidence during follow-up using Kaplan-Meier methods, and associated factors using regression models.

Results: At enrolment, among 1089 children [567 (52%) males, 587 (54%) aged <5 years and 530 (49%) with a HIV WHO stage III/IV], 112/332 (34%) had CD4 cell count <200 cells/μL among those aged 5-14 years. In children aged 5-14 years, SHD was diagnosed in 265/502 (53%) with a prevalence of 35-94% declining after 2013. Among children aged <5 years, 374/587 (64%) had SHD with no change over time. Male gender [adjusted odds ratio = 1.45; 95% confidence interval: 1.10-1.90], age <5 years versus older (1.64; 1.13-2.37), hospitalization versus outpatients (6.72; 3.35-13.5), antiretroviral treatment (ART) start within 30 days versus later (2.18; 1.52-3.13), and enrolment during 2013-2016 versus before (2.29; 1.54-3.41) were associated with SHD. After a median follow-up of 3.3 years [interquartile ratio: 0.8-7.8], 130 (12%) children died and 359 (35%) were LTFU. Predictors of mortality/LTFU were SHD [adjusted hazard ratio (aHR) = 1.54; 95% CI: 1.26-1.89], age <5 years versus older (1.28; 1.01-1.66), hospitalization versus outpatients (1.93; 1.42-2.63), living ≥50 km versus ≤1 km away (1.72; 1.37-2.16) and delayed ART initiation versus within 30 days (3.40; 2.70-4,27), while enrolment 2017-2023 versus before (0.51; 0.37-0.70) was protective.

Conclusions: The persisting high prevalence of paediatric SHD and high mortality/LTFU underscores the need for early diagnosis and care.

Keywords: advanced HIV diseases; mortality; paediatric HIV; prospective study; severe HIV disease.

PubMed Disclaimer

Conflict of interest statement

The authors report that there are no competing interests.

Figures

FIGURE 1
FIGURE 1
Flow chart of children in KIULARCO. KIULARCO, Kilombero and Ulanga Antiretroviral Cohort. AHD, advanced HIV disease; SHD, severe HIV disease. 1Children aged 0–4 years per WHO definition are considered to have AHD [8, 23].
FIGURE 2
FIGURE 2
Prevalence of severe HIV disease at enrolment by CD4 cell count and WHO stage according calendar year for age groups 0 to <5 years (a) and 5–14 years (b).
FIGURE 3
FIGURE 3
Combined rates of mortality/lost to follow‐up (LTFU) by age group (a), severity of HIV disease (b), and calendar year (c).
See this image and copyright information in PMC

References

    1. Knettel BA, Cichowitz C, Ngocho JS, et al. Retention in HIV care during pregnancy and the postpartum period in the option B+ era: a systematic review and meta‐analysis of studies in Africa. J Acquir Immune Defic Syndr. 2018;77(5):427. - PMC - PubMed
    1. Lyatuu GW, Mwashemele SZ, Urrio R, et al. Long‐term virological outcomes in women who started option B+ care during pregnancy for prevention of mother‐to‐child transmission of HIV in Dar es Salaam, Tanzania: a cohort study. Lancet HIV. 2021;8(5):e256‐e265. - PubMed
    1. Global H . AIDS statistics—Fact sheet Unaids org. 2021.
    1. WHO . Consolidated guidelines on HIV prevention, testing, treatment, service delivery and monitoring: recommendations for a public health approach. 2021. - PubMed
    1. Iyun V, Technau K‐G, Vinikoor M, et al. Variations in the characteristics and outcomes of children living with HIV following universal ART in sub‐Saharan Africa (2006–17): a retrospective cohort study. Lancet HIV. 2021;8(6):e353‐e362. doi:10.1016/S2352-3018(21)00004-7 - DOI - PMC - PubMed