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Travel

General precautions

  • Delay travel until clinically stable and treatment established
  • Provide drug prescription / letter listing ART and concomitant medications for comorbidities and referral letter for emergencies
  • Provide medical certificate for import of personal medicines/syringes
  • Carry ARVs split between suitcase and hand luggage
  • Beware of fake drugs
  • Advice on travel restrictions, see www.hivtravel.org or https://visaguide.world/news/countries-with-visa-restrictions-for-people-living-with-hiv/ or consult embassy or consular office of destination country

ART uptake

  • If possible, maintain hours of medicines (e.g., 23.00 local time) when switching time zones, shortening the interval to the next dose when flying east
  • For those on oral ART ensure sufficient supply
  • For those on an injectable LA regimen, consider when next injections are due, see Drug-drug Interactions and Other Prescribing Issues

Acknowledge increased susceptibility

Increased susceptibility of persons with HIV(i)

1. Observe food, respiratory and hand hygiene

  • Particularly important for travellers visiting friends and relatives (VFR)
  • To prevent bacterial enterocolitis, e.g., diarrhoeagenic E. coli, Salmonella, Shigella, Campylobacter and opportunistic intestinal parasitosis, e.g., Cryptosporidium, Cyclospora, Cystoisospora, Microsporidia
  • Consider mask wearing if circulating respiratory infections of concern

2. Prevent insect bites

  • Use repellents (DEET ≥ 30%) and spray clothing with insecticide (permethrin)
  • Sleep under insecticide-treated bednet
  • Wear long pants and long-sleeved clothes

3. Vaccination and prophylaxis

  • Ensure routine, standard of care vaccinations are up to date (see Immunisation in Persons with HIV)
  • Check if travel related vaccines are required (including SARS-CoV-2) and ensure there are no contraindications (e.g., Yellow Fever), see Immunisation in Persons with HIV 
  • Check if malaria chemoprophylaxis is required, according to malaria risk at travel destination and national guidelines (consider carrying emergency stand-by treatment)(ii)

Footnotes

  1. Higher intestinal susceptibility due to HIV-associated GALT destruction, low CD4 count. More severe malaria with CD4 count < 350 cells/μL
  2. Adherence counselling particularly important in persons visiting friends and relatives. 
    See Drug-drug Interactions between Anti-malarial Drugs and ARVs