{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T15:20:15Z","timestamp":1788448815650,"version":"build-2803163510"},"reference-count":48,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2026,2,9]],"date-time":"2026-02-09T00:00:00Z","timestamp":1770595200000},"content-version":"vor","delay-in-days":2,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000780","name":"European Union","doi-asserted-by":"publisher","award":["RIA2018CO-2512"],"award-info":[{"award-number":["RIA2018CO-2512"]}],"id":[{"id":"10.13039\/501100000780","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100005150","name":"Chinese Academy of Medical Sciences","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100005150","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,6,16]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Human immunodeficiency virus (HIV-1) infection leads to reduced telomere length (TL), a biomarker of immune aging. We investigated relationships between HIV viral load (VL) and CD4 count with TL and its rate of attrition in children with HIV from Zambia and Zimbabwe.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Buffy coat was obtained at baseline and 48 weeks from children aged 11\u201319 years with perinatally acquired HIV taking combination antiretroviral therapy (cART) for &amp;gt;6 months recruited into the VITALITY trial. Relative TL was measured using monochrome multiplex quantitative polymerase chain reaction, standardizing units for analysis. Cross-sectional analyses used multivariable linear regression adjusting for age, sex, and study site; longitudinal analysis additionally adjusted for baseline TL.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among participants at baseline (N = 842; mean \u00b1 SD age, 15.5 \u00b1 2.6 years; 53.2% female), 678 (80.5%) had HIV VL &amp;lt;60 copies\/mL, 66 (7.8%) had 60\u20131000 copies\/mL, and 98 (11.6%) had &amp;gt;1000 copies\/mL. The mean CD4 count was 584 \u00b1 243 cells\/\u03bcL. Compared to participants with VL &amp;lt;60 copies\/mL, those with VL &amp;gt;1000 copies\/mL had shorter TL (\u03b2 = \u2212.239 [95% confidence interval {CI}, \u2212.451 to \u2212.026]; P = .028), whereas those with 60\u20131000 copies\/mL did not (P = .836). Lower CD4 cell count was associated with shorter TL (\u03b2 = \u2212.038 [95% CI, \u2212.009 to \u2212.066] per 100 CD4 cells\/\u03bcL; P = .009). In longitudinal analysis (n = 783) after mean 336 \u00b1 6 days, those with HIV VL &amp;gt;1000 copies\/mL at both timepoints had an accelerated telomere attrition rate (\u03b2 = \u2212.276 [95% CI, \u2212.546 to \u2212.005]; P = .046) compared with participants with VL &amp;lt;1000 copies\/mL. Lower baseline CD4 count was associated with faster telomere attrition rate (\u03b2 = \u2212.033 [95% CI, \u2212.008 to \u2212.057]; P = .009).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>HIV VL &amp;gt;1000 copies\/mL among children with HIV on cART in Africa is associated with a degradation of immune age within 1 year, which may increase risk of comorbidities later in life.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical Trials Registration<\/jats:title>\n                    <jats:p>PACTR202009897660297.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/infdis\/jiag060","type":"journal-article","created":{"date-parts":[[2026,2,5]],"date-time":"2026-02-05T12:41:28Z","timestamp":1770295288000},"page":"e1407-e1417","source":"Crossref","is-referenced-by-count":1,"title":["Unsuppressed Viremia and Lower CD4 Count Associated With Faster Telomere Attrition in African Children With Perinatal Human Immunodeficiency Virus on Long-term Antiretroviral Therapy"],"prefix":"10.1093","volume":"233","author":[{"given":"Julian P G","family":"Shellard","sequence":"first","affiliation":[{"name":"Centre for Immuno-Oncology, Nuffield Department of Medicine, \u2060University of Oxford , Oxford ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1727-0336","authenticated-orcid":false,"given":"Emily","family":"Carr","sequence":"additional","affiliation":[{"name":"Institute for Infection and Immunity, City St George's, University of London , London ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8112-343X","authenticated-orcid":false,"given":"Gianni","family":"Tam-McMillan","sequence":"additional","affiliation":[{"name":"Centre for Immuno-Oncology, Nuffield Department of Medicine, \u2060University of Oxford , Oxford ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-4476-0318","authenticated-orcid":false,"given":"Emma W","family":"Mao","sequence":"additional","affiliation":[{"name":"Centre for Immuno-Oncology, Nuffield Department of Medicine, \u2060University of Oxford , Oxford ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1615-3856","authenticated-orcid":false,"given":"Hilda","family":"Mujuru","sequence":"additional","affiliation":[{"name":"Department of Paediatrics, University of Zimbabwe , Harare ,","place":["Zimbabwe"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hildah","family":"Banda Mabuda","sequence":"additional","affiliation":[{"name":"University Teaching Hospital, Women and Newborn Hospital, University of Zambia , Lusaka ,","place":["Zambia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0298-2397","authenticated-orcid":false,"given":"Molly","family":"Chisenga","sequence":"additional","affiliation":[{"name":"University Teaching Hospital, Women and Newborn Hospital, University of Zambia , Lusaka ,","place":["Zambia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0066-8345","authenticated-orcid":false,"given":"Tsitsi","family":"Bandason","sequence":"additional","affiliation":[{"name":"Health Research Unit Zimbabwe, Biomedical Research and Training Institute , Harare ,","place":["Zimbabwe"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3547-8146","authenticated-orcid":false,"given":"Nyasha V","family":"Dzavakwa","sequence":"additional","affiliation":[{"name":"Health Research Unit Zimbabwe, Biomedical Research and Training Institute , Harare ,","place":["Zimbabwe"]},{"name":"International Statistics and Epidemiology Group, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine , London ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7525-2382","authenticated-orcid":false,"given":"Lackson","family":"Kasonka","sequence":"additional","affiliation":[{"name":"University Teaching Hospital, Women and Newborn Hospital, University of Zambia , Lusaka ,","place":["Zambia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4897-458X","authenticated-orcid":false,"given":"Victoria","family":"Simms","sequence":"additional","affiliation":[{"name":"Health Research Unit Zimbabwe, Biomedical Research and Training Institute , Harare ,","place":["Zimbabwe"]},{"name":"International Statistics and Epidemiology Group, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine , London ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6414-0529","authenticated-orcid":false,"given":"Celia L","family":"Gregson","sequence":"additional","affiliation":[{"name":"Health Research Unit Zimbabwe, Biomedical Research and Training Institute , Harare ,","place":["Zimbabwe"]},{"name":"Global Musculoskeletal Research Group, Musculoskeletal Research Unit, Bristol Medical School, University of Bristol , Bristol ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rashida A","family":"Ferrand","sequence":"additional","affiliation":[{"name":"Health Research Unit Zimbabwe, Biomedical Research and Training Institute , Harare ,","place":["Zimbabwe"]},{"name":"Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine , London ,","place":["United 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