Children living with HIV in Europe: do migrants have worse treatment outcomes?
- PMID: 34596323
- PMCID: PMC9293243
- DOI: 10.1111/hiv.13177
Children living with HIV in Europe: do migrants have worse treatment outcomes?
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.
Keywords: Europe; HIV; children; migrant; mortality.
© 2021 The Authors. HIV Medicine published by John Wiley & Sons Ltd on behalf of British HIV Association.
Conflict of interest statement
CT reports grant funding via the Penta Foundation from ViiV Healthcare and Merck and receipt of honoraria/consultation fees from ViiV Healthcare. IJC and AJ report grants from Abbvie, Gilead Sciences and ViiV Healthcare through the Penta Foundation, and from the Collaborative Initiative for Paediatric HIV Education and Research and Penta Foundation outside the submitted work; all monies were paid to their institution. EC reports grant funding via Penta Foundation from ViiV Healthcare.
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