AETC National Resource Center


	participating institutions: Johns Hopkins University AIDS Service, New York State DOH AIDS Institute, The CORE Center, Cook County Hospital

NEWS AND NEW DEVELOPMENTS

The Human Immunodeficiency Virus-Infected Traveler [Castelli F and Patroni A. CID 2000;31:1403]: The authors provide a review of recommendations for international travel by HIV-infected patients. The following are major messages:

Malaria: HIV RNA levels are increased during acute malaria. Anti-malarial agents may cause drug interactions with protease inhibitors; this has been shown for methloquine and ritonavir, there is no information about proguanil plus chloroquine, and doxycycline appears to be safe.
Diarrhea: TMP-SMX may be useful for prophylaxis; fluoroquinolones are often preferred and may be given prophylactically to patients with low CD4 cell counts or carried for prn use by those with higher CD4 cell counts.
Vaccines: In general, live vaccines should be avoided, especially when the CD4 cell count is <200/mm³. Antibody response is often reduced, and this has been demonstrated with influenza, hepatitis A, and hepatitis B vaccines. The immune response is usually preserved even with low CD4 cell counts with polysaccharide vaccines such as pneumococcal and meningococcal vaccines. It has been shown that viral load levels increase transiently and return to baseline at four to six weeks after vaccinations. Recommendations for specific agents are provided in the table below:

Vaccine	Safety	Recommendation
Cholera	Risk of vaccine-induced disease	Live oral vaccine contraindicated Use killed oral/parenteral if needed
Influenza	Safe	Use when indicated
Diphtheria	Safe	Use when indicated
H. flu type B	Safe	Early vaccination
Hepatitis A	Safe	Use when traveling to endemic area
Hepatitis B	Safe	Early vaccination (check titers)
Jap B encephalitis	Safe	Use when indicated
Measles	Unsafe with low CD4	Avoid with CD4 <200/mm³
N. meningitidis	Safe	Use when indicated
Polio	OPV is unsafe	Avoid OPV; use elPV when indicated
S. pneumoniae	Safe	Often recommended
Rabies	Safe	Use when indicated
Tetanus	Safe	Use when indicated
Tick-borne encephalitis	Safe	Use when indicated
Tuberculosis	BCG unsafe	Avoid BCG
Typhoid fever	Live vaccine unsafe	Use V1 parenteral vaccine when indicated
Yellow fever	Unsafe with CD4 <200	Consider when indicated and CD4 >200

Travel restrictions: Over 150 countries have entry restrictions for people with HIV. Most of these are intended to prevent residency or work visas. Travel health professionals should provide this information to the potential traveler.
Antiretroviral agents: The following points are emphasized: 1) Travel may be ill-advised during early administration of HAART due to anticipated side effects; 2) many drugs are not available in other parts of the world so a full supply should be carried; 3) travelers taking indinavir must be aware of the need for large amounts of fluid; 4) these drugs may be considered markers of HIV at borders and customs; and 5) there may be interactions with other drugs taken during travel.
posted 1/18/2001

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