An increasing number of older perinatally infected undiagnosed children present with advanced disease for antiretroviral treatment (ART). The study aim was to describe the demographic and the clinical characteristics, and determine pre ART hospitalization of HIV-infected children at enrolment in HIV care in Gauteng province, South Africa. A cross sectional survey and medical records analysis was conducted with 149 caregivers of HIV infected children aged between 4–17 years. High proportion (n=58, 39.6%) of children were diagnosed between 6-17 years. The majority (n=131, 88.4%) presented at WHO clinical stages 3 and 4 and were severely immune compromised. Over three quarters (n=110, 82.1 %) had CD4 cell count <500 cells/mm3, and CD4 count decreased significantly with increasing diagnosis age (OR: -18.56, CI: -30.57 -6.54, P=.003). Three quarters (n=111, 75.4%) had mixed infections and (n=62, 41.6%) had tuberculosis. Almost half (n=71, 47.7%) were hospitalized and (n=29, 40.8%) had multiple admissions. Hospitalization was significantly associated with WHO clinical staging (OR; 2.10, CI: 1.06- 4.16, P=.032) and diagnosis age (OR; 1.19, CI: 0.67-0.93, P=.005). Undiagnosed perinatally infected older children and adolescents will benefit from early diagnosis and treatment by strengthening the provision of routine testing of this age group at primary care level.
