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We lack granular (age\u2010 and sex\u2010disaggregated) data on mortality among ALHIV, hence, this study aims to assess all\u2010cause mortality among ALHIV in a low\u2010resource setting.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>All adolescents ever initiated on antiretroviral treatment (ART, <jats:italic>N<\/jats:italic> = 1107) and their HIV\u2010negative peers (<jats:italic>N<\/jats:italic> = 456) aged 10\u201319 years, recruited as part of the Mzantsi Wakho study cohort, were followed up between 2014 and 2022 (yielding 12,427.7 person\u2010years of follow\u2010up). First, we assessed the proportion of deaths and estimated crude mortality incidence rates per 100 person\u2010years of follow\u2010up and their 95% confidence intervals, stratified by HIV status, sex and mode of HIV acquisition (vertical vs. sexual). We then estimated adjusted incidence rate ratios (IRRs) using Poisson regression adjusted for time\u2010varying age, sex and time on ART. Last, we used the Cox proportional hazards regression model to estimate the risk of death by ART adherence.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 1563 adolescents and young people were included in this analysis, 70.8% ALHIV and 57% female. More deaths occurred in ALHIV compared to their HIV\u2010negative peers (8.3% vs. 0.4%, <jats:italic>p<\/jats:italic>&lt;0.001). Among ALHIV, we observed a significantly higher proportion of deaths among males compared to females (10.7% vs. 7.1%, <jats:italic>p<\/jats:italic> = 0.036). Overall, mortality increased significantly with age, and males had a higher risk of mortality compared to females. Adolescents and youth living with vertically acquired HIV had a higher risk of mortality than those living with sexually acquired HIV. Comparing mortality rates by mode of HIV acquisition stratified by age and sex, mortality risk was higher among females aged 20+ years with vertically acquired HIV (IRR: 3.61, 95% CI 1.48\u20138.82) compared to females with sexually acquired HIV of the same age group. In a sub\u2010sample analysis, sustained ART adherence was associated with a lower risk of death (aHR: 0.44, 95% CI 0.23\u20130.85).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>ALHIV experience higher all\u2010cause mortality than their HIV\u2010negative peers, despite having initiated ART. Among ALHIV, mortality risk was higher among males and adolescents who acquired HIV vertically. Strategies to improve survival among ALHIV, including adolescent\u2010tailored care and support for adherence to ART, are urgently needed.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jia2.26522","type":"journal-article","created":{"date-parts":[[2025,6,25]],"date-time":"2025-06-25T07:15:04Z","timestamp":1750835704000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Age\u2010specific all\u2010cause mortality rates among adolescents and youth living with and without HIV: Evidence from a cohort study in South Africa"],"prefix":"10.1002","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6525-1244","authenticated-orcid":false,"given":"Siyanai","family":"Zhou","sequence":"first","affiliation":[{"name":"Centre for Social Science Research University of Cape Town  Cape Town South Africa"},{"name":"Division of Social and Behavioural Sciences School of Public Health Faculty of Health Sciences University of Cape Town  Cape Town South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3800-3173","authenticated-orcid":false,"given":"Elona","family":"Toska","sequence":"additional","affiliation":[{"name":"Centre for Social Science Research University of Cape Town  Cape Town South Africa"},{"name":"Department of Sociology University of Cape Town  Cape Town South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bulelani","family":"Gwampi","sequence":"additional","affiliation":[{"name":"Oxford Research South Africa University of Oxford  Oxford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2717-011X","authenticated-orcid":false,"given":"Leigh F.","family":"Johnson","sequence":"additional","affiliation":[{"name":"Centre for Infectious Disease Epidemiology and Research University of Cape Town  Cape Town South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janke","family":"Tolmay","sequence":"additional","affiliation":[{"name":"Centre for Social Science Research University of Cape Town  Cape Town South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wylene","family":"Saal","sequence":"additional","affiliation":[{"name":"Centre for Social Science Research University of Cape Town  Cape Town South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zea","family":"Leon","sequence":"additional","affiliation":[{"name":"Centre for Social Science Research University of Cape Town  Cape Town South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9938-6887","authenticated-orcid":false,"given":"Lucia","family":"Knight","sequence":"additional","affiliation":[{"name":"Division of Social and Behavioural Sciences School of Public Health Faculty of Health Sciences University of Cape Town  Cape Town South Africa"},{"name":"School of Public Health University of the Western Cape  Bellville South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0418-835X","authenticated-orcid":false,"given":"Lucie","family":"Cluver","sequence":"additional","affiliation":[{"name":"Department of Social Policy and Intervention University of Oxford  Oxford UK"},{"name":"Department of Child and Adolescent Psychiatry University of Cape Town  Cape Town South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,6,25]]},"reference":[{"key":"e_1_2_12_2_1","unstructured":"UNICEF.HIV and AIDS in adolescents: turning the tide against AIDS will require more concentrated focus on adolescents and young people.2020. 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