Children living with HIV in Europe: do migrants have worse treatment outcomes?
Journal Paper/Review - Oct 1, 2021
Chappell Elizabeth, 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, Spolou Vana, Warszawski Josiane, 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, European Pregnancy and Paediatric Infections Cohort Collaboration (EPPICC)
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.