HIV: recos traveling!

That is serious !

Here is the 2022 edition of the Health Advice for Travellers; a vintage that takes into account the current period “Omicron wave release of Sars-CoV-2 in France, while there are many uncertainties about the evolution of the Covid-19 pandemic”, explains the BEH editorial. On more than 100 pages, this special issue therefore offers all the necessary information for all those who want to travel, regardless of their state of health and their health needs. A large part of the document is devoted to vaccinations; others deal with insects (the large family of arthropods, in particular: bedbugs, ticks, mosquitoes, etc.) and their associated health risks, malaria, travelers’ diarrhea, transport-related risks, those related to the environment, those related to leisure activities to practices (sexual consumption, consumption of products. They even mention the administrative aspects (care abroad, repatriation, etc.). Finally, certain groups and populations are the subject of specific chapters according to their specific needs. Many structures ( scientific, official, etc. ) and experts have collaborated on this reference document: High Health Authority (HAS), National Agency for Drug Safety (ANSM), National Reference Center for Malaria, National Agency for Food, Environment and Occupational Safety ( ANSES), Ministry of Foreign Affairs, etc. In addition are the recommendations co Die The information contained in this document was approved by the Special Commission on Infectious and Emerging Diseases of the High Council on Public Health (HCSP) last April.

The most important points

In general, it is advisable to consult the website of the Ministry for Europe and Foreign Affairs before traveling abroad. “Every trip exposes you to risks that can be prevented with specialist advice or travel advice. In 2022, in view of the heterogeneous risk of infection by Sars-CoV-2, particular vigilance is required, although the improvement that can currently be observed is not synonymous with the end of the pandemic,” warn the authors of the report, BEH editors.

Regarding vaccinations, the most important point concerns Covid-19. It is reminded that entry and exit from French territory are carried out according to a country classification, regularly updated according to the evolution of the health situation and accessible on the website of the Ministry for Europe and Foreign Affairs. The list of names of vaccines against Covid-19 registered abroad and similar to those registered in Europe is available by country on the ANSM website. In addition, some countries have been included in the list of risk countries for certain diseases (tuberculosis, yellow fever, etc.). An important point concerns malaria. “The global malaria situation in 2021 is characterized by the increase in reported cases and deaths. The pressure put on health systems by the Covid-19 pandemic, particularly in low-income countries, has severely impacted their ability to sustain malaria control activities,” the experts explain. “In France, the increase in the number of cases compared to 2020 is very significant in 2021 (+117%) with the resumption of international travel. The countries of origin of the contamination are still predominantly in sub-Saharan Africa and Plasmodium falciparum [agent parasitaire qui cause la paludisme, ndlr] is involved in almost 89% of cases. One of the main risk factors for the severe form and death of malaria remains the delay in diagnosis, which is often associated with inappropriate treatment of patients during an initial consultation. This underscores the importance of prescribing appropriate prevention and follow-up care,” they say. In addition, chloroquine is no longer recommended for the treatment of malaria. The recommendations for the prevention of “jet lag”, the prevention of thromboembolic diseases, the prevention of motion sickness and the prevention of acute mountain sickness have also been updated.

For the first time, it is planned to update the online document as much as possible before the 2023 edition.To facilitate reader identification, the main changes compared to the 2021 edition of the Health Advice for Travelers are highlighted in orange text and tables.

Recommendations for PLHIV

According to the BEH (page 84), people with HIV (PLHIV) are among the groups of people for whom “specialist advice is justified before leaving the country”. Increased vigilance is required for:

  • the risk associated with certain infectious diseases in people living with HIV (leishmaniasis, salmonellosis, tuberculosis, intestinal coccidial infections, histoplasmosis and other fungal infections transmitted by inhalation, etc.);
  • the need for hygiene precautions, especially food;
  • Vaccinations (see relevant chapter: pages 7 to 32 of the BEH). The recommendations must be adjusted depending on the type of immunosuppression.

A November 2014 statement by the HCSP and for people living with HIV, the 2018 national recommendations formalize it:

  • Live attenuated vaccines such as yellow fever vaccines are generally contraindicated. In children with HIV, the CD4 count, which determines the contraindication to vaccination against yellow fever, varies with age. When yellow fever vaccine is administered in moderate immunodeficiency, the time to acquisition of immunity after vaccination appears to be prolonged and the duration of protection may be less than 10 years;
  • BCG is also contraindicated in these patients, regardless of age and CD4 count;
  • Inactivated vaccines are recommended as for all travelers. However, the response to vaccination may be altered or of short duration, warranting periodic monitoring of serology and may result in the administration of additional booster doses.

Interactions between disease-modifying treatment and drugs prescribed for travel:

  • Interactions between antiretrovirals and antimalarials exist but appear to have limited clinical implications, not justifying dose adjustments. The occurrence of an attack of malaria [une crise de palu, ndlr]is accompanied by a transient increase in viral load;
  • the risk of photosensitization from sulfonamides, which may be prescribed for prophylaxis of opportunistic infections in immunocompromised people living with HIV;
  • Exposure to the sun: People with weakened immune systems have a higher risk of skin cancer. Sun protection (clothing, hat and sunscreen) is strongly recommended.

Traveling with medication
For any information on security checks, regulations regarding the transport of medicines, liquids and medical equipment in the cabin, it is advisable to inquire with your airline or through the website of the General Directorate of Civil Aviation. Regarding customs clearance, it is recommended that the prescription be sent under its International Non-proprietary Name (INN) and preferably in English for regular processing. When traveling within the Schengen area with so-called common medicines, the quantity of medicines carried must always correspond to the duration of the medically prescribed treatment or otherwise a maximum of three months of treatment. In the case of narcotics or psychotropic drugs, the quantity transported must always be limited to what is necessary for personal use and the duration of the stay, and a separate permit must be applied for (from the state health authority – ARS – and ANSM). For travel outside the Schengen area with so-called common medicines, there is no harmonization of regulations and each country applies its own regulations. In addition to the medical prescription, each patient must check with the embassy (or consulate) of the country of destination in France before leaving to find out about the regulations in force. For narcotics or psychotropic drugs, each country applies its own regulations, it is essential to inquire at the embassy or consulate in France of the country of destination. Check the International Narcotics Control Board (INCB) website for different country regulations.

#HIV #recos #traveling

Leave a Comment

Your email address will not be published.