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The HIV-Infected Traveler. Merceditas Villanueva, MD Associate Professor of Medicine Yale University School of Medicine. The International AIDS Society–USA. From M Villanueva, MD, at New York, NY: March 22, 2010, IAS – USA. Travel Medicine.

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The HIV-Infected Traveler

Merceditas Villanueva, MDAssociate Professor of MedicineYale University School of Medicine

The International AIDS Society–USA

From M Villanueva, MD, at New York, NY: March 22, 2010, IAS–USA.

travel medicine
Travel Medicine
  • Developed as own discipline over past 25 years due to growth in international travel
  • Represented by ISTM and ASTMH clinical groups
  • Focus on pre-travel preventive care(as opposed to tropical medicine which focuses on diagnosis and treatment of illness acquired during foreign travel)
demographics of international travel in hiv infected patients
Pre-HAART(Kemper et. al. 1992-93)

Survey in hospital-based HIV clinic, California

46% had traveled within US; 20% with foreign travel within2 years

Median CD4=120/mm3

Reason for travel:

30% thought last chance to travel

Post-HAART(Sherrard 1997-2007)

International Health Clinic, Ottawa, Canada

57% foreign born: travel to visit friends and relatives

43% Canadian born: travel for vacation and business

Median CD4=440/mm3

Destinations: (in order)

Sub-Saharan Africa

Caribbean

Central America

South Asia

SE Asia

Demographics of International Travel in HIV-Infected Patients

Sherrard and McCarthy. Travel Medicine and Infectious Disease 2009; 7:291-295.

Kemper et. al. J Travel Med 1995; 2: 85-88.

initial travel preparation
Initial Travel Preparation
  • Check entry restrictions for HIV travelers
  • Travel health insurance
    • Medical care
    • Hospitalization
    • Evacuation
  • Obtaining medical care abroad
resources for country specific restrictions for hiv infected travelers
Resources for Country-Specific Restrictions for HIV-Infected Travelers
  • www.hivtravel.org:
    • Global Database on HIV-Related Travel Restrictions
    • Updated information from 196 countries, on regulations denying entry or residency for people living with HIV, based on relevant country legislation.
travel medicine practice assess health of hiv infected traveler
Specifics of travel itinerary

Risks related to type of travel

Immunization history

HIV status: CD4, VL

CD4<200, defer travel

Use of ARVs

If starting new regimen, wait 3 months before travel

Emphasize adherence despite challenges abroad

Pack sufficient amount in hand luggage; leave in marked prescription bottles

Travel Medicine Practice: Assess Health of HIV-Infected Traveler
considerations for malaria in hiv
Considerations for Malaria in HIV
  • Risk of acquiring malaria increased in HIV patients
  • HIV associated with increased risk of severe malaria
  • Malaria can worsen HIV infection

Whitworth J et. al. Lancet 2000; 356: 1051-1056.

Kublin J and Steketee R. J Infect Dis 2006; 193: 1-3.

diseases spread by fecal oral route precautions
Bottled fluids; boiled water

Cooked vegetables

Fruits that can be peeled

Symptomatic relief:

Loperamide

Bismuth subsalicylate

Yogurt

Diseases Spread by Fecal Oral Route: Precautions
characteristics of td in hiv
Characteristics of TD in HIV
  • Primarily caused by ETEC; also Salmonella, Campylobacter, Shigella, enteroaggregative E. coli; norovirus, rotavirus
  • In HIV-infected:
    • Bacterial pathogens often more severe with bacteremia
    • Cyclospora, Cryptosporidium, Isospora may lead to chronic diarrhea requiring longer treatment courses
summary
Summary
  • Assess the patient’s overall health status
  • Discuss HIV-related travel-entry restrictions
  • Assess the patient’s immunization needs including:
    • Required (mandated) immunizations
    • Destination-related (but optional) immunizations
    • Routine immunizations
  • Provide measures for pre- and post-exposure chemoprophylaxis for prevention of malaria and self-treatment of travelers’ diarrhea
  • Review personal disease prevention strategies
  • Refer to Travel Clinic
travel health resources
Travel Health Resources
  • CDC Travelers’ Health Website
    • www.cdc.gov/travel
  • World Health Organization
    • www.who.int/int
  • State Department
    • travel.state.gov
  • International Society of Travel Medicine
    • www.istm.org
  • Health Information for International Travel
    • CDC “Yellow Book”
  • International Travel and Health
    • WHO “Green Book”
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