Patten GMalateste KBolton Moore CSipambo NMokone LAnderegg NWools-Kaloustian KMichael DOdhiambo FKasozi CDesmonde SAmorissani-Folquet MLeroy VKumara Wati DNallusamy RKinikar AQuy DTYotebieng MEbasone PVLelo PPinto JRouzier VMachado DMHaw NJFord N2025-05-232025-Apr-010.1097/INF.0000000000004819https://pubs.cidrz.org/handle/123456789/10746Eligibility for antiretroviral therapy is no longer based on immune criteria. In a global cohort of 97,453 children, between 2005 and 2021, we observed large declines in CD4 measurement, from 51% to 12% among <5 seconds, and from 74% to 20% among those 5-14 years of age. Lack of CD4 testing may negatively affect clinical care and surveillance of severe immune suppression.