The scale-up of antiretroviral therapy (ART) has resulted in large numbers of children with perinatally-acquired HIV who would have died in early childhood with untreated HIV, reaching adolescence and adulthood. However, it is becoming known that children growing up with HIV are at risk of multisystem co-morbidities, despite ART. In Africa (where 90% of the world’s children with HIV live), the majority of the current cohort of older children and adolescents with HIV did not start ART in infancy, and HIV viral suppression rates are lower than those observed in adults. These factors increase the risk of co-morbidities. Children with HIV experience a range of comorbidities including cardio-respiratory, musculoskeletal and neurocognitive disease.

While there is awareness of the burden of chronic comorbidities in adults who are ageing with HIV, there is much less awareness of the burden of comorbidities in children growing up with HIV. Thus, HIV management guidelines and programmes have hitherto focused almost exclusively on achieving viral suppression. These comorbidities result in considerable disability and have wide-ranging effects such as poorer adherence, lower educational attainment and premature mortality. Addressing these comorbidities is critical for the well-being of children as they enter adulthood. The talk will summarise the existing evidence on the range and spectrum of co-morbidities, underlying drivers and draw out the outstanding research agenda.