Children living with HIV in Europe: do migrants have worse treatment outcomes?
Por:
Chappell E, Kohns Vasconcelos M, Goodall RL, Galli L, Goetghebuer T, Noguera-Julian A, Rodrigues LC, Scherpbier H, Smit C, Bamford A, Crichton S, Navarro ML, Ramos JT, Warszawski J, Spolou V, Chiappini E, Venturini E, Prata F, Kahlert C, Marczynska M, Marques L, Naver L, Thorne C, Gibb DM, Giaquinto C, Judd A, Collins IJ and European Pregnancy and Paediatric Infections Cohort Collaboration (EPPICC)
Publicada:
1 feb 2022
Ahead of Print:
1 oct 2021
Resumen:
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.
Filiaciones:
Chappell E:
MRC Clinical Trials Unit at UCL, London, UK
Kohns Vasconcelos M:
Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
Institute for Medical Microbiology and Hospital Hygiene, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, St. George's, University of London, London, UK
Goodall RL:
MRC Clinical Trials Unit at UCL, London, UK
Galli L:
Infectious Disease Unit, Department of Health Sciences, Meyer Children's Hospital, University of Florence, Florence, Italy
Goetghebuer T:
Department of Pediatrics, Hôpital St Pierre, Université libre de Bruxelles, Bruxelles, Belgium
Noguera-Julian A:
Infectious Diseases and Systemic Inflammatory Response in Pediatrics, Infectious Diseases Unit, Department of Pediatrics, Sant Joan de Déu Hospital Research Foundation, Barcelona, Spain
Center for Biomedical Network Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain
Department of Pediatrics, University of Barcelona, Barcelona, Spain
Translational Research Network in Pediatric Infectious Diseases (RITIP), Madrid, Spain
Rodrigues LC:
Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
Scherpbier H:
Emma Children's Hospital/Amsterdam University Medical Centre, Amsterdam, The Netherlands
Smit C:
Stichting HIV Monitoring, Amsterdam, The Netherlands
Bamford A:
MRC Clinical Trials Unit at UCL, London, UK
Great Ormond Street Hospital for Children NHS Trust, London, UK
University College London Great Ormond Street Institute of Child Health, London, UK
Crichton S:
MRC Clinical Trials Unit at UCL, London, UK
Navarro ML:
Translational Research Network in Pediatric Infectious Diseases (RITIP), Madrid, Spain
Hospital General Universitario "Gregorio Marañón", Madrid, Spain
Universidad Complutense, Madrid, Spain
Instituto de Investigación Sanitaria Gregorio Marañón (IISGM), Madrid, Spain
Ramos JT:
Departamento de Salud Pública y Materno-infantil, Universidad Complutense, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
Warszawski J:
Service d'Epidémiologie et Santé Publique, AP-HP, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
Unité de Recherche Clinique Paris Descartes Necker Cochin, AP-HP, Paris, France
Spolou V:
First Department of Paediatrics, Infectious Diseases Unit, "Agia Sophia" Childrens' Hospital, Athens, Greece
Chiappini E:
Infectious Disease Unit, Department of Health Sciences, Meyer Children's Hospital, University of Florence, Florence, Italy
Venturini E:
Infectious Disease Unit, Department of Health Sciences, Meyer Children's Hospital, University of Florence, Florence, Italy
Prata F:
Hospital de Santa Maria/CHULN, Lisbon, Portugal
Kahlert C:
Children's Hospital of Eastern Switzerland and Cantonal Hospital, Infectious Diseases and Hospital Epidemiology, St Gallen, Switzerland
Marczynska M:
Hospital of Infectious Diseases, Medical University of Warsaw, Warsaw, Poland
Marques L:
Centro Hospitalar e Universitário do Porto, Porto, Portugal
Naver L:
Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
Thorne C:
University College London Great Ormond Street Institute of Child Health, London, UK
Gibb DM:
MRC Clinical Trials Unit at UCL, London, UK
Giaquinto C:
Department of Women and Child Health, University of Padova, Padova, Italy
Judd A:
MRC Clinical Trials Unit at UCL, London, UK
Collins IJ:
MRC Clinical Trials Unit at UCL, London, UK
Green Published, hybrid, Green Accepted
|