Abstract
INTRODUCTION: Studies examining hospitalization among young children with HIV in resource-limited settings, in the context of early infant diagnosis and early antiretroviral therapy (ART) initiation, are limited. METHODS: We used routinely collected data to describe hospitalization patterns among children (age ≤5 years), born 2018-2022, who were diagnosed with HIV (Western Cape province, South Africa). We used mixed-effects Poisson models to examine factors associated with overall hospitalization and hospitalization after ART initiation. RESULTS: We included 2219 children, 30% were diagnosed with HIV at birth (≤7 days), an additional 41% before age 1 year, and 29% at age ≥1 year. Median follow-up from birth was 38 months (interquartile range 24-50). Overall, 67% of children were hospitalized, of whom 50% had >1 hospitalization. Excluding birth admissions, 35% of children were hospitalized before ART start ( n = 781/2219). Among children who started ART, 38% ( n = 747/1990) had admissions after ART start. Compared to children diagnosed with HIV at birth, overall hospitalization rates (excluding birth admissions) increased by 67% [95% confidence interval (CI): 39-101], 74% (95% CI: 45-109) and 29% (95% CI: 9-51%) among those diagnosed at age 1 week to 3 months, >3 to 9 months, and >9 months, respectively. Hospitalization rates after ART start were twice as high (103% increase; 95% CI: 68-146%) among children who had unsuppressed viral load (≥1000 copies/ml) at 4 or 12 months after ART start. CONCLUSIONS: High hospitalization rates occur among young children with HIV. Earlier HIV diagnosis, enabling earlier ART initiation, is associated with lower overall hospitalization rates. Unsuppressed viral load is associated with higher post-ART hospitalization rates.