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High HIV viral load linked to telomere shortening in childrenHigh HIV viral loads linked to faster aging in children

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Key Takeaway
High viral load and low CD4 count are associated with accelerated telomere attrition in children with perinatally acquired HIV.

This observational analysis from the VITALITY trial examined telomere length and attrition in 842 children aged 11-19 years with perinatally acquired HIV in Zambia and Zimbabwe, all on combination antiretroviral therapy (cART) for over 6 months. A longitudinal subset of 783 participants was followed for a mean of 336 days.

Participants with viral load (VL) >1000 copies/mL had significantly shorter telomere length compared to those with VL <60 copies/mL (β = -0.239; 95% CI [-0.451, -0.026]; P = 0.028). Similarly, lower CD4 count was associated with shorter telomeres (β = -0.038 per 100 cells/μL; 95% CI [-0.009, -0.066]; P = 0.009).

Over the follow-up period, those with sustained VL >1000 copies/mL experienced accelerated telomere attrition compared to those with VL <1000 copies/mL (β = -0.276; 95% CI [-0.546, -0.005]; P = 0.046). Lower baseline CD4 count also predicted faster attrition (β = -0.033; 95% CI [-0.008, -0.057]; P = 0.009).

These findings suggest that inadequate viral suppression in children on cART may promote immune aging, as indicated by telomere shortening. The study highlights the importance of maintaining low viral loads to preserve immune function in this population.

How this fits prior evidence

How this fits prior evidence: This finding addresses a gap in understanding the long-term biological impact of virological control in pediatric populations. While previous coverage noted that transition to adult care is associated with a decline in virological suppression among adolescents and young adults, these results highlight how poor viral control may specifically correlate with accelerated immune aging markers like telomere attrition.

Living with HIV as a child brings unique challenges for the body. A study of 842 children in Zambia and Zimbabwe looked at how the virus affects their cells over time. The researchers focused on telomeres, which are the protective caps at the ends of our chromosomes. Think of them like the plastic tips on shoelaces; they protect the DNA inside.

The study followed 783 children for about a year while they were on antiretroviral therapy. They found that children with high viral loads (over 1000 copies per milliliter) had shorter telomeres than those with low viral loads. Additionally, children with lower CD4 counts—the cells that help fight infection—showed faster telomere shortening.

While this study shows a clear link between high viral levels and faster cellular aging, it is important to remember it was an observational study. This means the researchers observed these patterns rather than testing a specific treatment's ability to stop aging. The findings highlight how critical it is to keep viral loads low to protect the long-term health of children living with HIV.

What this means for you:
High viral loads and lower CD4 counts are linked to faster cellular aging in children with HIV.

Common questions

What is a telomere and why does it matter?

Telomeres are protective caps at the ends of chromosomes. They protect our DNA as cells divide. When these caps get too short, it is a sign of cellular aging. This study found that children with high HIV viral loads had shorter telomeres than those with low viral loads.

How does the virus affect a child's body over time?

The study found that children with more than 1000 copies of the virus per milliliter showed an accelerated rate of telomere shortening. This means their cells were aging faster compared to children whose viral loads were kept under 1000 copies.

What role does the CD4 count play in this finding?

CD4 cells are vital for the immune system. The study found that a lower baseline CD4 count was associated with faster telomere attrition, which is the rate at which those protective caps shorten over time.

Study Details

Study typeRct
Sample sizen = 842
EvidenceLevel 2
Follow-up11.1 mo
PublishedJun 2026
View Original Abstract ↓
BACKGROUND: 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. METHODS: Buffy coat was obtained at baseline and 48 weeks from children aged 11-19 years with perinatally acquired HIV taking combination antiretroviral therapy (cART) for >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. RESULTS: Among participants at baseline (N = 842; mean ± SD age, 15.5 ± 2.6 years; 53.2% female), 678 (80.5%) had HIV VL <60 copies/mL, 66 (7.8%) had 60-1000 copies/mL, and 98 (11.6%) had >1000 copies/mL. The mean CD4 count was 584 ± 243 cells/μL. Compared to participants with VL <60 copies/mL, those with VL >1000 copies/mL had shorter TL (β = -.239 [95% confidence interval {CI}, -.451 to -.026]; P = .028), whereas those with 60-1000 copies/mL did not (P = .836). Lower CD4 cell count was associated with shorter TL (β = -.038 [95% CI, -.009 to -.066] per 100 CD4 cells/μL; P = .009). In longitudinal analysis (n = 783) after mean 336 ± 6 days, those with HIV VL >1000 copies/mL at both timepoints had an accelerated telomere attrition rate (β = -.276 [95% CI, -.546 to -.005]; P = .046) compared with participants with VL <1000 copies/mL. Lower baseline CD4 count was associated with faster telomere attrition rate (β = -.033 [95% CI, -.008 to -.057]; P = .009). CONCLUSIONS: HIV VL >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. CLINICAL TRIALS REGISTRATION: PACTR202009897660297.
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