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Human immunodeficiency virus (HIV) infection results in a gradual depletion of immune function, particularly CD4 cells. The CD4 assessment plays a significant role in assessing treatment responses and clinical decision-making for patients on combination antiretroviral therapy (ART) in resource-limited settings. However, new data on CD4 count changes are scarce; the volatility of CD4 counts after initiation of ART over time remains largely uncharacterized. This study aimed to identify the predictors of CD4 changes over time among HIV-infected children who began ART in Amhara, Ethiopia.    Methods  A retrospective follow-up study was performed. A total of 983 HIV-infected children who initiated ART in government hospitals in the Amhara region between 2010 and 2016 were included using a simple random sampling technique. Data were extracted using a structured checklist. An exploratory data analysis was carried out to explain individual and average profile plots. The linear mixed model was used to identify the CD4 change count predictors over time. Variables with  p  value < 0.05 were considered statistically significant in a multivariable linear mixed regression analysis.    Results  The mean CD4 count of the participants was 465.1 cells/mm 3  with an average CD4 count increase of 30.06 cells/mm 3  over 6 months from baseline CD4 count and ART initiation. Childhood age ( β  = − 0.015; 95% Cl − 0.021, − 0.009), opportunistic infection at ART initiation ( β  = − 0.044, 95% CI − 0.085, − 0.004), hemoglobin level ( β  = 0.013; 95% CI 0.004, 0.022), and baseline WHO clinical stage II ( β  = − 0.046, 95% CI − 0.091, − 0.0003) were significant predictors of CD4 changes over time.    Conclusions  The average CD4 count increase was sufficient in HIV patients who began combined antiretroviral therapy over time. The younger age of the infant, the higher baseline level of hemoglobin, the baseline WHO clinical stage II, and opportunistic infections led to changes in CD4 counts. As a result, timely diagnosis and treatment of opportunistic infections will reduce the risk of opportunistic infections.

Predictors of CD4 count changes over time among children who initiated highly active antiretroviral therapy in Ethiopia