Medical history and clinical examinations are insufficient to exclude vertical human immunodeficiency virus transmission in healthy, at‐risk adolescents

Vasconcelos, Malte Kohns; Laws, Hans‐Jürgen; Neubert, Jennifer

doi:10.1111/apa.14793

Cited by 2 publications

(2 citation statements)

References 8 publications

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“…First, there may be survivor bias of migrant children who survived the high mortality period of early infancy without ART [ 19 ], and were well enough to migrate. This may contribute to the lack of observed difference in the clinical outcomes in our study [ 20 ]. Further, we have not considered differences in access to ART.…”

Section: Discussionmentioning

confidence: 90%

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

et al. 2021

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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.

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Section: Discussionmentioning

confidence: 90%

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

et al. 2021

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“…The vertical transmission rate is currently estimated at 3-4% [28]. Most vertically infected children are asymptomatic in the first year after infection, and a substantial proportion (up to 25% in some cohorts) of vertically infected children remain asymptomatic into adolescence [29]. Forced migration and war are known to increase the risk of HIV transmission [30].…”

Section: Human Immunodeficiency Virusmentioning

confidence: 99%

Paediatric refugees from Ukraine: guidance for health care providers

et al. 2022

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BACKGROUND: With the invasion of Ukraine by the Russian Army in February 2022, refugees, the majority of whom are women and children, started fleeing the war to neighbouring countries. Even before the current escalation, the conflict in the eastern part of Ukraine has led to the internal displacement of more than 200,000 children, and many others have experienced attacks, e.g. on schools. This inevitably leads to limitations in health care delivery. During transit, overcrowding, poor shelter and vulnerability may further put refugees at increased risk for infectious diseases. This consensus document aims to provide information and guidance regarding health issues that paediatricians and general practitioners may face when caring for Ukrainian children. METHODS: Members of the Migrant Health Reference Group of Paediatrics Switzerland and the Paediatric Infectious Disease Group in Switzerland developed this recommendation between March and April 2022 in a modified Delphi process. RESULTS: A total of 50 recommendations were agreed on with a ≥80% consensus. These include the following topics: i) general aspects, including interpreter services, urgent health needs, personal history and general check-ups; ii) mental health, including how to search for signs of psychological distress without going into traumatic details; iii) vaccinations, including recommendations for evaluation and catch-up; iv) screening for tuberculosis, human immunodeficiency virus, and hepatitis B and C; and v) providing age-appropriate preventive and health service information. CONCLUSION: This document provides current evidence and guidance when caring for paediatric refugees from Ukraine. The recommendations focus on Switzerland but may well be used in other countries. These are based on current evidence and may need to be adapted to individual situations and once further evidence becomes available.

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Medical history and clinical examinations are insufficient to exclude vertical human immunodeficiency virus transmission in healthy, at‐risk adolescents

Cited by 2 publications

References 8 publications

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

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

Paediatric refugees from Ukraine: guidance for health care providers

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