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This study proposes a novel \u2018ratio\u2019 model that relates CD4+ T-cell counts of HIV-infected individuals to the CD4+ count reference values from healthy populations. We use mixed-effects regression to fit the model to data from 1616 children (median age 4.3 years at ART initiation) and 14,542 adults (median age 36 years at ART initiation). We found that the scaled carrying capacity, maximum CD4+ count relative to an HIV-negative individual of similar age, and baseline scaled CD4+ counts were closer to healthy values in children than in adults. Post-ART initiation, CD4+ growth rate was inversely correlated with baseline CD4+ T-cell counts, and consequently higher in adults than children. Our results highlight the impacts of age on dynamics of the immune system of healthy and HIV-infected individuals.<\/jats:p>","DOI":"10.7554\/elife.42390","type":"journal-article","created":{"date-parts":[[2021,1,14]],"date-time":"2021-01-14T08:08:45Z","timestamp":1610611725000},"update-policy":"https:\/\/doi.org\/10.7554\/elife.42390","source":"Crossref","is-referenced-by-count":1,"title":["A mechanistic model for long-term immunological outcomes in South African HIV-infected children and adults receiving ART"],"prefix":"10.7554","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5760-4847","authenticated-orcid":true,"given":"Eva Liliane","family":"Ujeneza","sequence":"first","affiliation":[{"name":"Department of Science and Technology and National Research Foundation, South African Centre for Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Stellenbosch, South Africa"},{"name":"African Institute for Mathematical Sciences (AIMS), Next Einstein 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