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.; Panto, 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.; Dona, D.; Rampon, O.; Romano, A.; Dodi, I.; Esposito, S.; Zuccaro, V.; Zanaboni, D.; Consolini, R.; Bernardi, S.; Genovese, O.; Cristiano, L.; Mazza, A.; Garazzino, S.; Mignone, F.; Silvestro, E.; Portelli, V.; Kinderziekenhuis, E.; van der Kuip, M.; Pajkrt, D.; Scherpbier, H. J.; de Boer, C.; Weijsenfeld, A. M.; Jurriaans, S.; Back, N. K. T.; Zaaijer, H. L.; Berkhout, B.; Cornelissen, M. T. E.; Schinkel, C. J.; Wolthers, K. C.; Fraaij, P. L. A.; van Rossum, A. M. C.; Vermont, C. L.; van der Knaap, L. C.; Visser, E.; Boucher, C. A. B.; Koopmans, M. P. G.; van Kampen, J. J. A.; Henriet, S. S. V.; van Aerde, M. K.; Strik-Albers, R.; Rahamat-Langendoen, J.; Stelma, F. F.; Burger, D.; Scholvinck, E. H.; de Groot-de Jonge, H.; Niesters, H. G. M.; van Leer-Buter, C. C.; Knoester, M.; Bont, L. J.; Geelen, S. P. M.; Loeffen, Y. G. T.; Wolfs, T. F. W.; Nauta, N.; Schuurman, R.; Hofstra, L. M.; Wensing, A. M. J.; Reiss, P.; Zaheri, S.; Boyd, A. C.; Bezemer, D. O.; van Sighem, A. I.; Smit, C.; Wit, F. W. M. N.; Hillebregt, M. M. J.; Woudstra, T. J.; Bergsma, D.; van de Sande, L.; Rutkens, T.; van der Vliet, S.; Lelivelt, K. J.; Scheijgrond, A.; de Groot, L.; van den Akker, M.; Bakker, Y.; EI Berkaoui, A.; Bezemer, M.; Bretin, N.; Djoechro, E.; Groters, M.; Kruijne, E.; Lelivelt, K. J.; Lodewijk, C.; Lucas, E.; Munjishvili, L.; Paling, F.; Peeck, B.; Ree, C.; Regtop, R.; Ruijs, Y.; Schoorl, M.; Schnorr, P.; Tuijn, E.; Veenenberg, L.; Visser, K. M.; Witte, E. C.; Ruijs, Y.; Popielska, J.; Pokorska-Spiewak, M.; Oldakowska, A.; Zawadka, K.; Coupland, U.; Doroba, M.; Teixeira, C.; Fernandes, A.; Soler-Palacin, P.; Antoinette Frick, M.; Perez-Hoyos, S.; Mur, A.; Lopez, N.; Mendez, M.; Mayol, L.; Vallmanya, T.; Calavia, O.; Garcia, L.; Coll, M.; Pineda, V.; Rius, N.; Rovira, N.; Duenas, J.; Fortuny, C.; Jose Mellado, M.; Escosa, L.; Garcia Hortelano, M.; Sainz, T.; Gonzalez-Tome, M. I.; Rojo, P.; Blazquez, D.; Prieto-Tato, L.; Epalza, C.; Tomas Ramos, J.; Guillen, S.; Navarro, M. L.; Saavedra, J.; Santos, M.; Santiago, B.; de Ory, S. J.; Carrasco, I.; Munoz-Fernandez, M. A.; Angel Roa, M.; Penin, M.; Martinez, J.; Badillo, K.; Onate, E.; Pocheville, I.; Garrote, E.; Colino, E.; Gomez Sirvent, J.; Garzon, M.; Roman, V.; Angulo, R.; Neth, O.; Falcon, L.; Terol, P.; Luis Santos, J.; Moreno, D.; Lendinez, F.; Peromingo, E.; Uberos, J.; Ruiz, B.; Grande, A.; Jose Romero, F.; Perez, C.; Lillo, M.; Losada, B.; Herranz, M.; Bustillo, M.; Collado, P.; Antonio Couceiro, J.; Vila, L.; Calvino, C.; Isabel Piqueras, A.; Oltra, M.; Gavilan, C.; Montesinos, E.; Dapena, M.; Alvarez, C.; Jimenez, B.; Gloria Andres, A.; Marugan, V.; Ochoa, C.; Alfayate, S.; Isabel Menasalvas, A.; del Prado, Y. R.; Navernaver, L.; Soeria-Atmadja, S.; Belfrage, E.; Hagas, V.; Aebi-Popp, K.; Anagnostopoulos, A.; Battegay, M.; Baumann, M.; Bernasconi, E.; Boni, J.; Braun, D. L.; Bucher, H. C.; Calmy, A.; Cavassini, M.; Ciuffi, A.; Crisinel, P. A.; Duppenthaler, A.; Dollenmaier, G.; Egger, M.; Elzi, L.; Fehr, J.; Fellay, J.; Francini, K.; Furrer, H.; Fux, C. A.; Gunthard, H. F.; Haerry, D.; Hasse, B.; Hirsch, H. H.; Hoffmann, M.; Hosli, I.; Huber, M.; Kaiser, L.; Keiser, O.; Klimkait, T.; Kottanattu, L.; Kouyos, R. D.; Kovari, H.; Ledergerber, B.; Martinetti, G.; Martinez de Tejada, B.; Marzolini, C.; Metzner, K. J.; Muller, N.; Nicca, D.; Paioni, P.; Pantaleo, G.; Perreau, M.; Polli, C.; Rauch, A.; Rudin, C.; Scherrer, A. U.; Schmid, P.; Speck, R.; Stockle, M.; Sultan-Beyer, L.; Tarr, P.; Thanh Lecompte, M.; Trkola, A.; Vernazza, P.; Wagner, N.; Wandeler, G.; Weber, R.; Yerly, S.; Lyall, H.; Butler, K.; Doerholt, K.; Doherty, C.; Foster, C.; Harrison, I.; Kenny, J.; Klein, N.; Letting, G.; Mcmaster, P.; Murau, F.; Nsangi, E.; Prime, K.; Riordan, A.; Shackley, F.; Shingadia, D.; Storey, S.; Tudor-Williams, G.; Turkova, A.; Welch, S.; Cook, C.; Dobson, D.; Fairbrother, K.; Gibb, D. M.; Prevost, M. L.; Van Looy, N.; Peters, H.; Francis, K.; Thrasyvoulou, L.; Welch, S.; Fidler, K.; Bernatoniene, J.; Manyika, F.; Sharpe, G.; Subramaniam, B.; Hague, R.; Price, V.; Flynn, J.; Cardoso, A.; Abou - Rayyah, M.; Klein, N.; Bamford, A.; Shingadia, D.; Yeadon, S.; Segal, S.; Hawkins, S.; Dowie, M.; Bandi, S.; Percival, E.; Eisenhut, M.; Duncan, K.; Anguvaa, L.; Wren, L.; Flood, T.; Pickering, A.; Mcmaster, P.; Murphy, C.; Daniels, J.; Lees, Y.; Thompson, F.; Williams, A.; Williams, B.; Pope, S.; Libeschutz, S.; Cliffe, L.; Southall, S.; Freeman, A.; Freeman, H.; Christie, S.; Gordon, A.; Rosie Hague, D.; Clarke, L.; Jones, L.; Brown, L.; Greenberg, M.; Benson, C.; Riordan, A.; Ibberson, L.; Shackley, F.; Patel, S.; Hancock, J.; Doerholt, K.; Prime, K.; Sharland, M.; Storey, S.; Lyall, E. G. H.; Foster, C.; Seery, P.; Tudor-Williams, G.; Kirkhope, N.; Raghunanan, S.; Kenny, J.; Callaghan, A.; Bridgwood, A.; Mcmaster, P.; Evans, J.; Blake, E.; Yannoulias, 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.