The Travel Clinic: Dr. Mark Wise

The Special Traveller: HIV and AIDS

Planning a trip when you have an underlying medical problem sometimes presents problems. When that medical problem is infection with HIV or AIDS, it can be quite a challenge, particularly when your destination is tropical. Food and water borne diseases, vector borne infections, and the inoculations themselves may pose important risks to this group of travellers. Aside from the medical concerns, just the logistical problems of crossing borders or carrying medications may also a formidable task.

The role of the travel medicine advisor is not to judge whether certain individuals should travel. Rather, it is to explain the risks, offer measures to minimize those risks, and to educate the traveller as to how to deal with medical problems should they arise. Prevention and anticipation are the keys.

HIV From the point of view of pre-travel inoculation, the risk factors such as destination, duration and style of travel should be considered as with any other traveller. However, there are a few points to keep in mind when immunizing the HIV infected traveller. Firstly, live vaccines should be avoided, especially in anyone who is immunosuppressed as evidenced by a CD4 count of less than 200. This would preclude yellow fever vaccine, oral typhoid (Vivotif) and oral polio vaccine and measles vaccine. Typhim Vi, an inactivated vaccine, is a safe alternative for typhoid, as is IPV for polio. For those who must venture to an area of high risk for yellow fever, one might consider administering the shot, as while the risk is theoretical, it has been given in the past without adverse effects. Where the risk is likely low, a certificate of exemption may be given.

Tuberculosis is usually of little threat to the average traveller. But HIV infected patients are at significantly greater risk. Therefore TB skin testing should be performed prior to and after any extended travel where exposure is likely. BCG, a live vaccine with questionable efficacy against TB, is contraindicated. Another concern is whether or not the immunosuppressed patient will respond adequately to any particular vaccine. In the case of hepatitis B, a double dose has been advocated. Because of this possible limitation, personal measures to avoid disease are critical.

This is exceedingly important with respect to food and water borne disease. While Traveller’s Diarrhea is usually but an inconvenience, it may be debilitating and life threatening to someone with AIDS. Patients with AIDS often have a decrease in stomach acid, which reduces their defences against gastrointestinal infections. It takes a much smaller inoculum, or a smaller mistake, to become ill.

Bacterial infections such as salmonella, shigella and campylobacter are often much more severe and prolonged in AIDS patients, sometimes leading to a chronic carrier state. They may spread to the bloodstream as well. A group of "spore forming" protozoa, including cryptosporidia, microsporidia, isospora and cyclospora may also lead to severe, dehydrating, and sometimes fatal diarrhea. The severity of the infection is proportional to the immune status of the individual. Effective treatment for these infections particular infections is unfortunately lacking.

Drive Protected Therefore, the need to adhere to food and water precautions is critical. Bottled water, if sealed, should be safe. Water filters and chemicals such as iodine do not eradicate cryptosporidia, and therefore boiling is the best alternative. Beer and carbonated drinks are usually trustworthy.

Prophylactic antibiotics such as Cipro or Noroxin are an excellent idea in the short term (less than 3 weeks) traveller to a location where the food and water may be contaminated. Sulfa, in addition to predisposing one to photosensitivity or a drug rash, is less likely to be effective, and hence a poor choice. Fortunately, enterotoxigenic E. coli, the commonest cause of Traveller’s Diarrhea, is no more severe in patients with AIDS.

Neither is malaria, thank goodness. But insect precautions and an appropriate antimalarial should be prescribed. Two insect-borne infections, Chagas’ disease and visceral leishmaniasis may be associated with more severe illness in HIV-infected individuals. Luckily, they are rare.

Sexually transmitted diseases such as syphilis, gonorrhea and chancroid are much more common in the tropics. Once again, patients with AIDS are susceptible to more severe clinical disease. Abstinence or safe sex must be the rule, as it is for all travellers.

There are several "bureaucratic" issues that need to be dealt with in the case of the HIV infected traveller. Firstly, at least 50 countries, particularly in Eastern Europe and the Middle East prohibit the entry of HIV-infected individuals. Proof of HIV testing may be required, depending upon the purpose and length of stay in the host country. These specific restrictions should be available through a travel clinic or Health Canada (613-954-3236).

Anticipation is paramount. Carry adequate supplies of all current or potentially required medications and supplies. These should be accompanied by a letter from your physician. It is sometimes prudent to mail your medication in advance to someone at your destination. Have the name of a medical contacts should the need arise. Carry adequate medical insurance.

Realistically, travelling with medical problems such as HIV infection may present limitations. But hopefully, with proper pre-travel counselling and careful attention to personal behaviour, the joy of travel can be realized.




Home About us Appointments Before you go While you're away After your return The special traveller Inflammatory bowel disease HIV/AIDS The pregnant traveller Diabetes Travelling to adopt Women's issues Travel quotes FAQs Contact us	The Special Traveller: HIV and AIDS Planning a trip when you have an underlying medical problem sometimes presents problems. When that medical problem is infection with HIV or AIDS, it can be quite a challenge, particularly when your destination is tropical. Food and water borne diseases, vector borne infections, and the inoculations themselves may pose important risks to this group of travellers. Aside from the medical concerns, just the logistical problems of crossing borders or carrying medications may also a formidable task. The role of the travel medicine advisor is not to judge whether certain individuals should travel. Rather, it is to explain the risks, offer measures to minimize those risks, and to educate the traveller as to how to deal with medical problems should they arise. Prevention and anticipation are the keys. From the point of view of pre-travel inoculation, the risk factors such as destination, duration and style of travel should be considered as with any other traveller. However, there are a few points to keep in mind when immunizing the HIV infected traveller. Firstly, live vaccines should be avoided, especially in anyone who is immunosuppressed as evidenced by a CD4 count of less than 200. This would preclude yellow fever vaccine, oral typhoid (Vivotif) and oral polio vaccine and measles vaccine. Typhim Vi, an inactivated vaccine, is a safe alternative for typhoid, as is IPV for polio. For those who must venture to an area of high risk for yellow fever, one might consider administering the shot, as while the risk is theoretical, it has been given in the past without adverse effects. Where the risk is likely low, a certificate of exemption may be given. Tuberculosis is usually of little threat to the average traveller. But HIV infected patients are at significantly greater risk. Therefore TB skin testing should be performed prior to and after any extended travel where exposure is likely. BCG, a live vaccine with questionable efficacy against TB, is contraindicated. Another concern is whether or not the immunosuppressed patient will respond adequately to any particular vaccine. In the case of hepatitis B, a double dose has been advocated. Because of this possible limitation, personal measures to avoid disease are critical. This is exceedingly important with respect to food and water borne disease. While Traveller’s Diarrhea is usually but an inconvenience, it may be debilitating and life threatening to someone with AIDS. Patients with AIDS often have a decrease in stomach acid, which reduces their defences against gastrointestinal infections. It takes a much smaller inoculum, or a smaller mistake, to become ill. Bacterial infections such as salmonella, shigella and campylobacter are often much more severe and prolonged in AIDS patients, sometimes leading to a chronic carrier state. They may spread to the bloodstream as well. A group of "spore forming" protozoa, including cryptosporidia, microsporidia, isospora and cyclospora may also lead to severe, dehydrating, and sometimes fatal diarrhea. The severity of the infection is proportional to the immune status of the individual. Effective treatment for these infections particular infections is unfortunately lacking. Therefore, the need to adhere to food and water precautions is critical. Bottled water, if sealed, should be safe. Water filters and chemicals such as iodine do not eradicate cryptosporidia, and therefore boiling is the best alternative. Beer and carbonated drinks are usually trustworthy. Prophylactic antibiotics such as Cipro or Noroxin are an excellent idea in the short term (less than 3 weeks) traveller to a location where the food and water may be contaminated. Sulfa, in addition to predisposing one to photosensitivity or a drug rash, is less likely to be effective, and hence a poor choice. Fortunately, enterotoxigenic E. coli, the commonest cause of Traveller’s Diarrhea, is no more severe in patients with AIDS. Neither is malaria, thank goodness. But insect precautions and an appropriate antimalarial should be prescribed. Two insect-borne infections, Chagas’ disease and visceral leishmaniasis may be associated with more severe illness in HIV-infected individuals. Luckily, they are rare. Sexually transmitted diseases such as syphilis, gonorrhea and chancroid are much more common in the tropics. Once again, patients with AIDS are susceptible to more severe clinical disease. Abstinence or safe sex must be the rule, as it is for all travellers. There are several "bureaucratic" issues that need to be dealt with in the case of the HIV infected traveller. Firstly, at least 50 countries, particularly in Eastern Europe and the Middle East prohibit the entry of HIV-infected individuals. Proof of HIV testing may be required, depending upon the purpose and length of stay in the host country. These specific restrictions should be available through a travel clinic or Health Canada (613-954-3236). Anticipation is paramount. Carry adequate supplies of all current or potentially required medications and supplies. These should be accompanied by a letter from your physician. It is sometimes prudent to mail your medication in advance to someone at your destination. Have the name of a medical contacts should the need arise. Carry adequate medical insurance. Realistically, travelling with medical problems such as HIV infection may present limitations. But hopefully, with proper pre-travel counselling and careful attention to personal behaviour, the joy of travel can be realized.