IV Infection and Travel: Pretravel Recommendations and Health-Related Risks. Top HIV Med

IV Infection and Travel: Pretravel Recommendations and Health-Related Risks. Top HIV Med

In the current era of globalization and ease of air travel combined with the increased survival attained since the advent of potent antiretroviral therapy, HIV-infected individuals are travelling to remote and resource-limited areas of the world. Travel-related health risks in a patient with HIV depend on the patient’s immune status, destination, travel itinerary, and type of travel. HIV-infected patients with a CD4+ count of 200 cells/mm3 or lower, particularly those who are treatment-naive and newly diagnosed, are at increased risk of complications when travelling to resource-poor settings. These increased risks include those of acquiring gastrointestinal, respiratory, and endemic tropical infectious diseases. Individuals with a CD4+ count higher than 200 cells/mm3 (whether receiving antiretroviral treatment or not) are considered to have limited immune deficiency for the purpose of travel-related recommendations; in general, they may safely receive most recommended and required vaccines. Pretravel consultation before departure is crucial to address strategies to protect against vaccine-preventable diseases (routine, recommended, and required vaccinations); vector-borne diseases, particularly malaria; gastrointestinal infections; and sexually transmitted diseases. HIV-infected travellers who are ill, particularly those with fever, should undergo an immediate medical evaluation to rule out the possibility of a life-threatening infectious disease such as malaria.

Editors’ note: This excellent review should be required reading for all UN staff living with HIV who travel internationally or who live in resource-constrained settings. It compiles current knowledge on the use of live attenuated and inactivated vaccines by CD4+ count and provides practical advice. This includes delaying travel until 3 months after starting antiretroviral treatment to avoid immune reconstitution syndromes during travel, keeping medication with its official documentation in hand luggage with a back-up supply in checked luggage, hand hygiene with water and soap or alcohol-based solutions, knowing about potential protease inhibitor drug interactions with malaria treatment, careful attention to water and food safety to avoid enteric infections, adherence to safer sex strategies, and the importance of prompt evaluation of fever while travelling or on return .