Chappell, Elizabeth; Kohns Vasconcelos, Malte; Goodall, Ruth L; Galli, Luisa; Goetghebuer, Tessa; Noguera-Julian, Antoni; Rodrigues, Laura C; Scherpbier, Henriette; Smit, Colette; Bamford, Alasdair; +18 more... 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 Collaboratio; (2021) Children living with HIV in Europe: do migrants have worse treatment outcomes? HIV Medicine, 23 (2). pp. 186-196. ISSN 1464-2662 DOI: https://doi.org/10.1111/hiv.13177
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Abstract
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.
Item Type | Article |
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Faculty and Department | Faculty of Epidemiology and Population Health > Dept of Infectious Disease Epidemiology & International Health (2023-) |
Research Centre | Centre for Maternal, Reproductive and Child Health (MARCH) |
PubMed ID | 34596323 |
Elements ID | 166452 |
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