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

Journal Paper/Review - Oct 1, 2021


Chappell E, Chiappini E, Venturini E, Prata F, Kahlert C, Marczynska M, Marques L, Naver L, Thorne C, Gibb D, Giaquinto C, Judd A, Collins I, Spolou V, Warszawski J, Kohns Vasconcelos M, Goodall R, Galli L, Goetghebuer T, Noguera-Julian A, Rodrigues L, Scherpbier H, Smit C, Bamford A, Crichton S, Navarro M, Ramos J, European Pregnancy and Paediatric Infections Cohort Collaboration (EPPICC). Children living with HIV in Europe: do migrants have worse treatment outcomes?. HIV Med 2021
Journal Paper/Review (English)
HIV Med 2021
Publication Date
Oct 1, 2021
Issn Electronic
Brief description/objective

To assess the effect of migrant status on treatment outcomes among children living with HIV in Europe.

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.

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).

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.