title: Country of birth does not influence long-term clinical, virologic, and immunological outcome of HIV-infected children living in the Netherlands: a cohort study comparing children born in the Netherlands with children born in Sub-Saharan Africa.
abstract: BACKGROUND
  Immigrant HIV-infected adults in industrialized countries show a poorer clinical and virologic outcome compared with native patients. We aimed to investigate potential differences in clinical, immunological, and virologic outcome in Dutch HIV-infected children born in the Netherlands (NL) versus born in Sub-Saharan Africa (SSA) in a national cohort analysis.
  
  
  METHODS
  We included all HIV-infected children registered between 1996 and 2013. Descriptive statistics, mixed-effects models, and Cox proportional hazard models were used to investigate differences between groups.
  
  
  RESULTS
  In total, 319 HIV-infected children were registered. The majority of these children were born in SSA (n = 148, 47%) or NL (n = 113, 36%) and most were black (n = 158, 61%). Children born in NL were diagnosed at a median age of 1.2 years and initiated combination antiretroviral therapy (cART) at a median age of 2.6 years, compared with 3.7 and 5.3 years, respectively, for children born in SSA (HIV diagnosis: P < 0.001; cART initiation: P < 0.001). Despite a lower initial CD4 T-cell Z-score in children born in SSA, their immunological reconstitution was similar to children from NL. Virologic suppression was achieved in the majority of all cART-treated children (NL: 96%, SSA: 94%). There was no difference in the occurrence or timing of virologic failure.
  
  
  CONCLUSIONS
  Most immigrant HIV-infected children living in NL were born in SSA. Children born in SSA were diagnosed and initiated cART at an older age than children born in NL. Despite initial differences in CD4 T-cell counts and HIV viral load, the long-term immunological and virologic response to cART was similar in both groups.
authors.affiliation: *Department of Pediatric Haematology, Immunology and Infectious Diseases, Emma Children's Hospital, Academic Medical Center, Amsterdam, the Netherlands; †Dutch HIV Monitoring Foundation, Amsterdam, the Netherlands; ‡Department of Pediatrics, Division of Infectious Diseases, Immunology and Rheumatology, Erasmus MC University Hospital Rotterdam/Sophia Children's Hospital, Rotterdam, the Netherlands; §Erasmus MC/Viroscience Lab, Erasmus MC, Rotterdam, the Netherlands; ‖The Nijmegen Institute for Infection, Inflammation and Immunity, Radboud University Medical Center, Nijmegen, the Netherlands; and ¶Department of Pediatric Infectious Diseases and Immunology, Wilhelmina Children's Hospital/University Medical Center, Utrecht, the Netherlands.
authors.forename: Sophie
authors.initials: S
authors.lastname: Cohen
authors.forename: Ward P H
authors.initials: WP
authors.lastname: van Bilsen
authors.forename: Colette
authors.initials: C
authors.lastname: Smit
authors.forename: Pieter L A
authors.initials: PL
authors.lastname: Fraaij
authors.forename: Adilia
authors.initials: A
authors.lastname: Warris
authors.forename: Taco W
authors.initials: TW
authors.lastname: Kuijpers
authors.forename: Sibyl P M
authors.initials: SP
authors.lastname: Geelen
authors.forename: Tom F W
authors.initials: TF
authors.lastname: Wolfs
authors.forename: Henriette J
authors.initials: HJ
authors.lastname: Scherpbier
authors.forename: Annemarie M C
authors.initials: AM
authors.lastname: van Rossum
authors.forename: Dasja
authors.initials: D
authors.lastname: Pajkrt
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D054242:Emigrants and Immigrants; D005006:Ethnicity; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000188:drug therapy* / Q000276:immunology / Q000821:virology; D006801:Humans; D007223:Infant; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D016896:Treatment Outcome; D019562:Viral Load
chemical_list: D044966:Anti-Retroviral Agents