Abstract: Objective To analyze the survival status of children living with HIV in Zhaojue County and to investigate the factors associated with their survival time. Methods A retrospective cohort study was conducted, compiling follow-up data for pediatric HIV patients residing in Zhaojue County between 1996 and 2022. The observation endpoint was December 31, 2022. The life table method was utilized to calculate cumulative survival rates. Differences in survival times across various subgroups were compared using the log-rank test, and a Cox proportional hazards regression model was employed to perform the survival analysis. Results The study cohort comprised 925 children living with HIV, with a mean observation time of 66.0 months (95% CI: 63.3-68.7). The cumulative survival rates at 6 months, 1 year, 5 years, 10 years, and 15 years were 95%, 92%, 87%, 80%, and 73%, respectively. Multivariate Cox proportional hazards regression analysis indicated that the period of case diagnosis (1996-2008: HR=0.331, 95% CI: 0.125-0.878; 2009-2017: HR=1.742, 95% CI: 1.074-2.825), treatment status (untreated or lost to follow-up: HR=51.254, 95% CI: 32.221-81.531), and WHO Clinical Stage III of HIV infection (HR=9.527, 95% CI: 3.430-26.462) were statistically significant predictors of survival time. Conclusion It is imperative to prioritize the expansion of antiretroviral therapy (ART) coverage for children living with HIV, especially those diagnosed between 2009 and 2017, those who are treatment-naïve, and those who have advanced to WHO Clinical Stage III. Expediting the restoration of patients' immune function is critical to prolonging their survival.

Key words: HIV, Pediatrics, Survival analysis, Associated factors