Children living with HIV in Europe
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Children living with HIV in Europe : do migrants have worse treatment outcomes? / Chappell, Elizabeth; Kohns Vasconcelos, Malte; Goodall, Ruth L; Galli, Luisa; Goetghebuer, Tessa; Noguera-Julian, Antoni; Rodrigues, Laura C; Scherpbier, Henriette; Smit, Colette; Bamford, Alasdair; Crichton, Siobhan; Navarro, Marissa Luisa; Ramos, Jose T; Warszawski, Josiane; Spolou, Vana; Chiappini, Elena; Venturini, Elisabetta; Prata, Filipa; Kahlert, Christian; Marczynska, Magdalena; Marques, Laura; Naver, Lars; Thorne, Claire; Gibb, Diana M; Giaquinto, Carlo; Judd, Ali; Collins, Intira Jeannie; European Pregnancy and Paediatric Infections Cohort Collaboration (EPPICC).
In: HIV MED, Vol. 23, No. 2, 02.2022, p. 186-196.Research output: SCORING: Contribution to journal › Short publication › Research › peer-review
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TY - JOUR
T1 - Children living with HIV in Europe
T2 - do migrants have worse treatment outcomes?
AU - Chappell, Elizabeth
AU - Kohns Vasconcelos, Malte
AU - Goodall, Ruth L
AU - Galli, Luisa
AU - Goetghebuer, Tessa
AU - Noguera-Julian, Antoni
AU - Rodrigues, Laura C
AU - Scherpbier, Henriette
AU - Smit, Colette
AU - Bamford, Alasdair
AU - Crichton, Siobhan
AU - Navarro, Marissa Luisa
AU - Ramos, Jose T
AU - Warszawski, Josiane
AU - Spolou, Vana
AU - Chiappini, Elena
AU - Venturini, Elisabetta
AU - Prata, Filipa
AU - Kahlert, Christian
AU - Marczynska, Magdalena
AU - Marques, Laura
AU - Naver, Lars
AU - Thorne, Claire
AU - Gibb, Diana M
AU - Giaquinto, Carlo
AU - Judd, Ali
AU - Collins, Intira Jeannie
AU - European Pregnancy and Paediatric Infections Cohort Collaboration (EPPICC)
N1 - Short Communication
PY - 2022/2
Y1 - 2022/2
N2 - 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.
AB - 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.
KW - Adolescent
KW - Anti-HIV Agents/therapeutic use
KW - Child
KW - Europe/epidemiology
KW - HIV Infections/diagnosis
KW - Humans
KW - Transients and Migrants
KW - Treatment Outcome
KW - Viral Load
U2 - 10.1111/hiv.13177
DO - 10.1111/hiv.13177
M3 - Short publication
C2 - 34596323
VL - 23
SP - 186
EP - 196
JO - HIV MED
JF - HIV MED
SN - 1464-2662
IS - 2
ER -
