Eliot C. Heher, MD
Patients with HIV disease who travel abroad may encounter some unique risks. Some pre-travel vaccinations may be inappropriate for HIV positive travelers. The risk of acquiring infections abroad may be higher. Some countries also have discriminatory policies towards HIV positive travelers that may make entrance to the country difficult. Despite these facts, patients with HIV can travel safely and enjoyably simply by taking a few extra precautions. Visiting with a travel medicine specialist well in advance is an important part of ensuring a successful trip.
Vaccinations “The risk of diarrheal illness is greater in travelers with HIV infection and particularly in those with AIDS.”
In general, patients with AIDS should avoid live vaccinations. The actual risk of live vaccines depends on the degree of immune system impairment and must be individualized. Live vaccines include Yellow fever, Measles/Mumps/Rubella, Varicella, Oral Polio vaccine, and BCG vaccine (which is rarely used in the United States). Some physicians feel that measles vaccine is safe1. Others feel that Yellow fever vaccination should be avoided for HIV positive travelers with a CD4 count of less than 2002. Patients with HIV should discuss the risks of traveling to a yellow fever area with their physicians and should generally avoid such travel if possible. Inactivated vaccines are safe for patients with HIV disease and should be administered as they would be in other travelers. In general, patients with HIV should plan to meet with their physicians at least three months before embarking in order to discuss vaccinations and other issues that may affect their journey.
The risk of diarrheal illness is greater in travelers with HIV infection and particularly in those with AIDS. These travelers must be especially vigilant about avoiding uncooked meats and seafood and avoiding tap water in areas where it is of questionable quality. It is not generally recommended that HIV patients take antibiotics to prevent traveler’s diarrhea. When traveler’s diarrhea does occur, however, it is wise to be prepared with a hydration kit and, in certain cases, antibiotics. HIV infected travelers should discuss with their physician, ahead of time, whether carrying antibiotics to be used in the event of certain diarrheal symptoms is wise for them.
Restrictions on Travel
There are still countries that may deny traveler’s admission if they are known to be HIV positive. Some may even require HIV testing for travelers who plan on an extended visit for study or work. HIV positive travelers should check with the consulate of each on their itinerary for an update on their policies.
Gompel, AV. et al. Journal of Travel Medicine; 4:136-143 p138.)
Steffen R. Rickenback M. Wilhelm U. et al. J Infect Dis; 1987; 156:84-90.)
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