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

Chappell, E.; Kohns Vasconcelos, M.; Goodall, R. L.; Galli, L.; Goetghebuer, T.; Noguera-Julian, A.; Rodrigues, L. C.; Scherpbier, H.; Smit, C.; Bamford, A.; Crichton, S.; Navarro, M. L.; Ramos, J. T.; Warszawski, J.; Spolou, V.; Chiappini, E.; Venturini, E.; Prata, F.; Kahlert, C.; Marczynska, M.; Marques, L.; Naver, L.; Thorne, C.; Gibb, D. M.; Giaquinto, C.; Judd, A.; Collins, I. J.; Goodall, R.; Rodrigues, L.; Duff, C.; Goodall, R.; Gomezpena, D.; Jackson, C.; Lundin, R.; Mangiarini, L.; Milanzi, E.; Nardone, A.; Hainaut, M.; Van Der Kelen, E.; Delforge, M.; Le Chenadec, J.; Ramos, E.; Dialla, O.; Wack, T.; Laurent, C.; Ait Si Selmi, L.; Leymarie, I.; Ait Benali, F.; Brossard, M.; Boufassa, L.; Floch-Tudal, C.; Firtion, G.; Hau, I.; Chace, A.; Bolot, P.; Blanche, S.; Granier, M.; Labrune, P.; Lachassine, E.; Dollfus, C.; Levine, M.; Fourcade, C.; Heller-Roussin, B.; Runel-Belliard, C.; Tricoire, J.; Monpoux, F.; Chirouze, C.; Reliquet, V.; Brouard, J.; Kebaili, K.; Fialaire, P.; De Villeneuve, A.; Lalande, M.; De Flandres, J.; Mazingue, F.; Partisani, M. L.; De Martino, M.; Angelo Tovo, P.; Gabiano, C.; Carloni, I.; Larovere, D.; Baldi, F.; Miniaci, A.; Pession, A.; Badolato, R.; Pantò, G.; Anastasio, E.; Montagnani, C.; Bianchi, L.; Allodi, A.; Di Biagio, A.; Grignolo, S.; Giacomet, V.; Marchisio, P.; Banderali, G.; Tagliabue, C.; Cellini, M.; Bruzzese, E.; Di Costanzo, P.; Lo Vecchio, A.

doi:10.1111/hiv.13177

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.

Children living with HIV in Europe: do migrants have worse treatment outcomes? / Chappell, E.; Kohns Vasconcelos, M.; Goodall, R. L.; Galli, L.; Goetghebuer, T.; Noguera-Julian, A.; Rodrigues, L. C.; Scherpbier, H.; Smit, C.; Bamford, A.; Crichton, S.; Navarro, M. L.; Ramos, J. T.; Warszawski, J.; Spolou, V.; Chiappini, E.; Venturini, E.; Prata, F.; Kahlert, C.; Marczynska, M.; Marques, L.; Naver, L.; Thorne, C.; Gibb, D. M.; Giaquinto, C.; Judd, A.; Collins, I. J.; Goodall, R.; Rodrigues, L.; Duff, C.; Goodall, R.; Gomezpena, D.; Jackson, C.; Lundin, R.; Mangiarini, L.; Milanzi, E.; Nardone, A.; Hainaut, M.; Van Der Kelen, E.; Delforge, M.; Le Chenadec, J.; Ramos, E.; Dialla, O.; Wack, T.; Laurent, C.; Ait Si Selmi, L.; Leymarie, I.; Ait Benali, F.; Brossard, M.; Boufassa, L.; Floch-Tudal, C.; Firtion, G.; Hau, I.; Chace, A.; Bolot, P.; Blanche, S.; Granier, M.; Labrune, P.; Lachassine, E.; Dollfus, C.; Levine, M.; Fourcade, C.; Heller-Roussin, B.; Runel-Belliard, C.; Tricoire, J.; Monpoux, F.; Chirouze, C.; Reliquet, V.; Brouard, J.; Kebaili, K.; Fialaire, P.; De Villeneuve, A.; Lalande, M.; De Flandres, J.; Mazingue, F.; Partisani, M. L.; De Martino, M.; Angelo Tovo, P.; Gabiano, C.; Carloni, I.; Larovere, D.; Baldi, F.; Miniaci, A.; Pession, A.; Badolato, R.; Pantò, G.; Anastasio, E.; Montagnani, C.; Bianchi, L.; Allodi, A.; Di Biagio, A.; Grignolo, S.; Giacomet, V.; Marchisio, P.; Banderali, G.; Tagliabue, C.; Cellini, M.; Bruzzese, E.; Di Costanzo, P.; Lo Vecchio, A.. - In: HIV MEDICINE. - ISSN 1464-2662. - 23:2(2022), pp. 186-196. [10.1111/hiv.13177]