Children living with HIV in Europe: do migrants have worse treatment outcomes?

• Published in: HIV medicine Vol. 23; no. 2; pp. 186 - 196
• Main Authors: Chappell, Elizabeth, Kohns Vasconcelos, Malte, Galli, Luisa, Navarro, Marissa Luisa, Venturini, Elisabetta, Marques, Laura, Naver, Lars, Duff, Charlotte, Milanzi, Edith, Ramos, Elisa, Dialla, Olivia, Leymarie, Isabelle, Granier, Michèle, Runel‐Belliard, Camille, Kebaili, Kamila, Mazingue, Françoise, Badolato, Raffaele, Anastasio, Elisa, Bianchi, Leila, Cellini, Monica, Donà, Daniele, Genovese, Orazio, Pajkrt, D, Weijsenfeld, A.M., Zaaijer, H.L., Cornelissen, M.T.E., Fraaij, P.L.A., Vermont, C.L., van der Knaap, L.C., van Aerde, M. K., Boyd, A.C., Wit, F.W.M.N., Bergsma, D, van den Akker, M., Munjishvili, L., Peeck, B., Regtop, R., Ruijs, Y., Schoorl, M., Veenenberg, L., Pokorska‐Śpiewak, Maria, Ołdakowska, Agnieszka, Teixeira, Carla, Pérez‐Hoyos, Santiago, López, Núria, Rius, Neus, José Mellado, María, Escosa, Luis, González‐Tomé, María Isabel, Navarro, María Luisa, Carrasco, Itzíar, Gómez Sirvent, Jorge, Garzón, Mónica, Román, Vicente, Lendínez, Francisco, José Romero, Francisco, Lillo, Miguel, Herranz, Mercedes, Bustillo, Matilde, Montesinos, Elena, Jiménez, Beatriz, Soeria‐Atmadja, Sandra, Belfrage, Erik, Baumann, M, Cavassini, M, Elzi, L, Fux, CA, Pantaleo, G, Speck, R, Trkola, A, Yerly, S, Lyall, Hermione, Harrison, Ian, Klein, Nigel, Murau, Fungai, Nsangi, Edith, Tudor‐Williams, Gareth, Cook, Claire, Dobson, Donna, Gibb, Diana M., Fidler, K, Subramaniam, B, Price, V, Flynn, J, Bamford, A, Anguvaa, L, Wren, L, McMaster, P, Lees, Y, Thompson, F, Southall, S, Clarke, L, Patel, S, Hancock, J, Prime, K, Sharland, M, Lyall, EGH, Seery, P, Kenny, Julia, Evans, J
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01.02.2022; Wiley; John Wiley and Sons Inc
• Subjects: Acquired immune deficiency syndrome; Adolescent; AIDS; Anti-HIV Agents - therapeutic use; Antiretroviral agents; Antiretroviral therapy; Child; Children; Clinical outcomes; Confidence intervals; Europe; Europe - epidemiology; HIV; HIV Infections - diagnosis; Human health and pathology; Human immunodeficiency virus; Humans; Immunology; Immunosuppression; Life Sciences; Medicin och hälsovetenskap; Microbiology and Parasitology; migrant; Migrants; mortality; Public health; Short Communication; Short Communications; Transients and Migrants; Treatment Outcome; Tuberculosis; Viral Load; Europe; mortality; HIV; migrant; children; Europe
• ISSN: 1464-2662; 1468-1293; 1468-1293
• DOI: 10.1111/hiv.13177

Objectives To assess the effect of migrant status on treatment outcomes among children living with HIV in Europe. Methods Children aged < 18 years at the start of antiretroviral therapy (ART) in European paediatric HIV observational cohorts where ≥ 5% of children were migrants (defined as born abroad) were included. Three outcomes were considered: (i) severe immunosuppression‐for‐age; (ii) viraemic viral load (≥ 400 copies/mL) at 1 year after ART initiation; and (iii) AIDS/death after ART initiation. The effect of migrant status was assessed using univariable and multivariable logistic and Cox models. Results Of 2620 children included across 12 European countries, 56% were migrants. At ART initiation, migrant children were older than domestic‐born children (median 6.1 vs. 0.9 years, p < 0.001), with slightly higher proportions being severely immunocompromised (35% vs. 33%) and with active tuberculosis (2% vs. 1%), but a lower proportion with an AIDS diagnosis (14% vs. 19%) (all p < 0.001). At 1 year after beginning ART, a lower proportion of migrant children were viraemic (18% vs. 24%) but there was no difference in multivariable analysis (p = 0.702), and no difference in severe immunosuppression (p = 0.409). However, there was a trend towards higher risk of AIDS/death in migrant children (adjusted hazard ratio = 1.51, 95% confidence interval: 0.96–2.38, p = 0.072). Conclusions After adjusting for characteristics at ART initiation, migrant children have virological and immunological outcomes at 1 year of ART that are comparable to those who are domestic‐born, possibly indicating equity in access to healthcare in Europe. However, there was some evidence of a difference in AIDS‐free survival, which warrants further monitoring.