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However, challenges persist, including virological failure (VF) and suboptimal immune recovery. This study aimed to describe clinical, virological and immunological outcomes of ELHIV individuals in Spain since 2020, and to identify factors associated with VF and impaired immune recovery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A multicentre, retrospective cohort study was conducted using data from 642 ELHIV individuals actively followed in the CoRISpe and CoRISpe-FARO cohorts. Data included demographics, ART history, virological suppression (viral load \u226450\u2005copies\/mL), CD4\/CD8 ratio and CDC immunological categories. Logistic regression identified factors influencing VF and immune progression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The median age of participants was 24\u2005years, with 67.6% aged \u226518. Most (93.6%) acquired HIV via vertical transmission, with ART initiated at a median age of 1.93\u2005years. At the time of analysis, 99.1% were on ART. Although 81.1% achieved virological suppression, 10.5% experienced VF, associated with PI-based regimens, independent of age, and a lower CD4 nadir. Immune recovery, defined as a CD4\/CD8 ratio \u22651, was achieved by 52.3%. Impaired recovery was linked to older age at ART initiation and lower CD4 nadir, particularly among adolescents (12\u201318\u2005years) and young adults. Children (&amp;lt;12\u2005years) showed better immune profiles, with 97.8% achieving CD4 counts \u2265500 cells\/mm\u00b3.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Early ART initiation and tailored interventions are essential to optimize outcomes in ELHIV populations. PI-based regimens were a risk factor for VF, whereas integrase strand transfer inhibitors appeared protective. Adolescents and young adults require targeted support to improve adherence and immune recovery, aligning with UNAIDS goals.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/jac\/dkag079","type":"journal-article","created":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T12:56:14Z","timestamp":1771505774000},"source":"Crossref","is-referenced-by-count":0,"title":["Clinical and immunovirological status in children, adolescents and young adults with early-life-acquired HIV: a Spanish multi-cohort analysis since 2020"],"prefix":"10.1093","volume":"81","author":[{"given":"Laura","family":"Tarancon-Diez","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Pediatric Infectious Diseases Unit, Gregorio Mara\u00f1\u00f3n University Hospital, Gregorio Mara\u00f1\u00f3n Research Health Institute (IiSGM) , Madrid ,","place":["Spain"]},{"name":"Biomedical Research Centre Network for Infectious Diseases (CIBERINFEC), Carlos III Health Institute , Madrid ,","place":["Spain"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Beatriz","family":"Lazaro-Martin","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Pediatric Infectious Diseases Unit, Gregorio Mara\u00f1\u00f3n University Hospital, Gregorio Mara\u00f1\u00f3n Research Health Institute (IiSGM) , Madrid ,","place":["Spain"]},{"name":"Biomedical Research Centre Network for Infectious Diseases (CIBERINFEC), Carlos III Health Institute , Madrid ,","place":["Spain"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Javier","family":"Goicoechea-Mart\u00ednez","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Pediatric Infectious Diseases Unit, Gregorio Mara\u00f1\u00f3n University Hospital, Gregorio Mara\u00f1\u00f3n Research Health Institute (IiSGM) , Madrid ,","place":["Spain"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Raquel","family":"Dom\u00ednguez-Romero","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Pediatric Infectious Diseases Unit, Gregorio Mara\u00f1\u00f3n University Hospital, Gregorio Mara\u00f1\u00f3n Research Health Institute (IiSGM) , Madrid ,","place":["Spain"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jorge","family":"G\u00f3mez Sirvent","sequence":"additional","affiliation":[{"name":"University Hospital Nuestra Se\u00f1ora de la Candelaria Department of Pediatrics, , Santa Cruz de Tenerife ,","place":["Spain"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elisa","family":"Garrote","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Hospital Universitario Basurto , Bilbao, Vizcaya ,","place":["Spain"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laura","family":"Minguell Domingo","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Hospital Universitari Arnau de Vilanova , Lleida ,","place":["Spain"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elo\u00edsa","family":"Cervantes-Hern\u00e1ndez","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Hospital Universitario Virgen de la Arrixaca , Murcia ,","place":["Spain"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"C\u00e9sar","family":"Gavil\u00e1n","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Hospital San Juan de Alicante , Sant Joan d'Alacant ,","place":["Spain"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cl\u00e0udia","family":"Fortuny","sequence":"additional","affiliation":[{"name":"Pediatric Infectious Diseases and Microbiome Research Group, Institut de Recerca Sant Joan de D\u00e9u ,","place":["Spain"]},{"name":"Departament de Cirurgia I Especialitats Medicoquir\u00fargiques, Facultat de Medicina I Ci\u00e8ncies de la Salut, Universitat de Barcelona , Barcelona ,","place":["Spain"]},{"name":"Biomedical Research Centre Network for Epidemiology and Public Health (CIBERESP) , Carlos III Health Institute, Madrid ,","place":["Spain"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3501-8529","authenticated-orcid":false,"given":"Jose Ignacio","family":"Bernardino","sequence":"additional","affiliation":[{"name":"Biomedical Research Centre Network for Infectious Diseases (CIBERINFEC), Carlos III Health Institute , Madrid ,","place":["Spain"]},{"name":"HIV and Infectious Diseases Unit, Hospital Universitario La Paz, Instituto de Investigaci\u00f3n Hospital Universitario La Paz (IdiPAZ) , Madrid ,","place":["Spain"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cristina","family":"Diez","sequence":"additional","affiliation":[{"name":"Biomedical Research Centre Network for Infectious Diseases (CIBERINFEC), Carlos III Health Institute , Madrid ,","place":["Spain"]},{"name":"HIV and Infectious Diseases Unit, Hospital General Universitario Gregorio Mara\u00f1\u00f3n, Instituto de Investigaci\u00f3n Sanitaria Gregorio Mara\u00f1\u00f3n (IiSGM) , Madrid ,","place":["Spain"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marta","family":"Montero-Alonso","sequence":"additional","affiliation":[{"name":"Infectious Diseases Unit, La Fe University and Polytechnic Hospital , Valencia ,","place":["Spain"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cristina","family":"Roca-Oporto","sequence":"additional","affiliation":[{"name":"Institute of Biomedicine of Seville (IBiS), Virgen del Rocio University Hospital, Spanish National Research Council (CSIC), University of Seville, Clinical Unit of Infectious Diseases, Microbiology and Parasitology , Seville 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,","place":["Spain"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luis","family":"Escosa-Garc\u00eda","sequence":"additional","affiliation":[{"name":"Biomedical Research Centre Network for Infectious Diseases (CIBERINFEC), Carlos III Health Institute , Madrid ,","place":["Spain"]},{"name":"Department of Pediatrics, Infectious and Tropical Diseases, La Paz University Hospital, Hospital La Paz Institute for Health Research (Idipaz) , Madrid ,","place":["Spain"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luis","family":"Prieto","sequence":"additional","affiliation":[{"name":"Biomedical Research Centre Network for Infectious Diseases (CIBERINFEC), Carlos III Health Institute , Madrid ,","place":["Spain"]},{"name":"Department of Paediatrics, Pediatric Research and Clinical Trials Unit (UPIC), Fundaci\u00f3n Para la Investigaci\u00f3n Biom\u00e9dica del Hospital 12 de Octubre, Instituto de Investigaci\u00f3n Sanitaria Hospital 12 de Octubre (I+12) , 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