Children living with HIV in Europe: do migrants have worse treatment outcomes?
HIV Med
; 23(2): 186-196, 2022 02.
Article
in En
| MEDLINE
| ID: mdl-34596323
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.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Transients and Migrants
/
HIV Infections
/
Anti-HIV Agents
Type of study:
Diagnostic_studies
/
Prognostic_studies
Limits:
Adolescent
/
Child
/
Humans
Country/Region as subject:
Europa
Language:
En
Journal:
HIV Med
Journal subject:
SINDROME DA IMUNODEFICIENCIA ADQUIRIDA (AIDS)
Year:
2022
Document type:
Article
Affiliation country:
United kingdom