HIV infection: precautions for HIV-infected travellers

Travelling overseas can expose you to many diseases that you are not exposed to at home. Taking precautions for avoiding these diseases is always important, but even more so for people with HIV infection, especially those whose immune systems are severely compromised.

People with HIV infection are more susceptible to some infections and can also develop more severe illness when they contract infections. In addition, some vaccines and preventive medicines recommended for overseas travellers are not suitable for people with HIV infection.

If you have HIV, you should discuss your travel plans and the countries and areas you intend to visit with your doctor, or a travel medicine professional, to plan what precautions are necessary for you.

CD4 cell counts and travel

Your susceptibility to infections and the vaccinations that are safe and effective for you are affected by the strength of your immune system. Your doctor may suggest checking your immune status, including measuring the concentration of CD4 (immune) cells and HIV-RNA in your blood. Your doctor may also review your antiretroviral therapy (HIV medicines, or ART).

If you are newly diagnosed with HIV infection and have a CD4 count of 200 cells per mm3 or less, then experts recommend you delay travel until your CD4 counts improve after ART treatment. Ideally, people with HIV infection should have been on stable ART treatment for at least 3 months before longer journeys.

However, if travel cannot be delayed and your immune system is weak then consider discussing with your doctor other precautions you can take, such as prophylaxis (preventive medicine) against some infections.

Food and waterborne diseases

If travelling to developing countries, you should be careful about food and waterborne diseases, such as Salmonella, Cryptosporidium and Giardia infections.

Food and drinks that carry a risk of contamination include raw fruits and vegetables, raw and undercooked seafood, meat, tap water and ice made from tap water, unpasteurised milk and dairy products, and food and drinks purchased from street vendors.

Foods that are generally considered to be less risky include dishes that have been well cooked at a reputable source, fruits that you peel yourself, bottled water (especially if carbonated), beverages made with boiled water, such as tea and coffee, and water that has been boiled then cooled.

If you need to use local sources of water and it's not possible to boil the water, you could consider taking a portable water filtration unit to increase the safety of the water.

You can also contract waterborne infections if you swallow water when swimming or undertaking other water sports.

To reduce the risk of catching waterborne diseases such as cryptosporidiosis and giardiasis (intestinal illnesses caused by tiny organisms called protozoa), you should try to avoid swallowing water when swimming and, if you are not sure of the safety of the water, do not swim. Unfortunately, many areas that you may want to swim in may be contaminated with sewerage or animal waste.

Washing your hands or using hand sanitiser frequently, particularly before eating, is also important to prevent gastroenteritis.

Travellers’ diarrhoea and HIV infection

Antimicrobial medicines are available to help prevent travellers’ diarrhoea, although many are not recommended for HIV-infected people as they may have adverse effects and could promote the emergence of drug-resistant organisms.

However, in certain circumstances (such as travel in an area where the risk of infection is very high), your doctor may consider it necessary to prescribe preventive antibiotics. You should discuss this matter with your doctor or a travel medicine professional.

Also consider taking antimicrobial medicine with you when travelling in developing countries to treat diarrhoea if it develops. You should consult your doctor as to which type would best suit you as some commonly used medicines may interact with ART medicines.

Medicines such as Imodium (loperamide) and Lomotil (diphenoxylate-atropine) may also be of benefit if you develop diarrhoea while travelling. However, if the diarrhoea persists for longer than 48 hours or is accompanied by blood in the stools or fever with shaking chills, or if you become dehydrated, you should stop taking these medicines and seek medical attention immediately.

Vaccinations and HIV infection

When considering vaccinations that may be needed for travelling, it is generally recommended that HIV-infected people avoid vaccines that contain live virus, as they may cause serious adverse reactions.

However, one exception to this is the measles vaccine, which is advised for HIV-positive people who do not already have immunity and who have CD4 cell counts over 200 cells per mm3. This vaccination, however, is not recommended for people with AIDS who have severely compromised immune systems, and another form of vaccination should be used.

If you will be at risk of exposure to yellow fever, you will need to discuss the use of yellow fever vaccine with your doctor or travel health professional, as this is also a live virus vaccine and can cause adverse reactions. In addition, the efficacy of the vaccine cannot be guaranteed in people with HIV infection. Experts recommend that yellow fever vaccine be given to travellers who have a significant risk of yellow fever if they have a CD4 cell count over 200 cells per mm3.

If you are not vaccinated and are travelling in areas where yellow fever is a risk, you may need to consider other preventive measures. You may also need to carry a waiver letter from your doctor.

Because HIV-infected travellers can generally receive inactivated (killed) vaccines, you can be vaccinated against diseases such as hepatitis A and B, typhoid, tetanus, rabies and Japanese encephalitis. However, caution may be needed with the current oral inactivated cholera vaccine.

If you need polio vaccination, an inactivated (or killed) polio vaccine is safe. The oral (live) polio vaccine is no longer available in Australia.

Malaria and HIV infection

General protective measures against mosquito bites, such as mosquito nets and insect repellents, are essential, as malaria can be a very serious illness for HIV-positive people and can also worsen HIV infection.

Medicines to prevent malaria are often needed, and you should discuss with your doctor or travel health professional the options available if you intend to travel in a malaria area. Some malaria tablets are not recommended as they may interact with ART medicines or may not be as effective for HIV-positive individuals.

Other risks

HIV-infected travellers are at greater risk of infection from diseases such as visceral leishmaniasis, which is transmitted by sandflies, and a number of fungal infections. Also, many tropical and developing countries are considered high risk for transmission of tuberculosis.

You should ask your doctor or travel health professional about other specific areas of risk in the countries in which you’ll be travelling and discuss ways to minimise your exposure to infections.

HIV medicines and travel

If you are taking ART medicines to treat HIV infection then you should take with you enough supply for the duration of your trip. This may be safest in your hand luggage. The World Health Organization recommends that you carry a letter from your doctor explaining your need for these life-saving medicines but not mentioning HIV infection.

While you are travelling, it is essential that you do not miss or delay your doses of ART. If you change time zones, you may need to adapt your dosing schedule. Also some HIV medicines need to be kept refrigerated. Your doctor may be able to help you work out the exact requirements in your case.


 

Last Reviewed: 13 January 2010

myDr, 2000. Adapted from original material sourced from MediMedia.
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