Questions and Answers with NAM Chris Gadd, editor, HIV & Aids Treatments Directory, NAM
I’m travelling abroad and going to need vaccinations. Aren’t
they dangerous for people with HIV?
Vaccines stimulate an immune response in your body to produce antibodies against
organisms that cause disease. This prevents you becoming ill if you are later
infected with the disease-causing organism or ‘pathogen’.
There are three types of vaccine. Live attenuated vaccines contain the whole
organism that causes disease, but in a weakened form, so it’s unable
to cause disease. Inactivated vaccines contain dead organisms which cannot
cause infection, but which the immune system can still recognise. Sub-unit
vaccines contain only a fragment or part of the organism which is unable to
cause infection but which is still sufficient to prime the immune system against
the whole organism.
In people with HIV, the only type that can be dangerous are live attenuated
vaccines. These can end up causing the disease they set out to prevent in
people with damaged immune systems. In general, HIV positive people should
avoid these.
So, can I still go away?
It will depend on where you’re going and which vaccines you need. Most
required for travel are either inactivated or sub-unit vaccines, so are safe
for HIV positive people. These include tetanus, polio, cholera, typhoid, rabies
and hepatitis A and B vaccines.
However, the vaccine for yellow fever is live, so in general, it is recommended
that HIV positive people do not have it. Yellow fever is a disease transmitted
by mosquito bites and is present in central Africa and South America. Some
countries there require you to have a certificate stating you have been vaccinated
for immigration purposes.
Does that mean I can’t travel to these areas?
It’s worth discussing yellow fever vaccination with your doctor. Although
the vaccine is not recommended for people with HIV, this is due to a lack
of information on its safety, rather than certainty about it being dangerous.
Some doctors will agree to vaccinate patients with relatively high CD4 cell
counts and no HIV-related symptoms, as the risk of developing problems is
fairly low.
If you are not vaccinated and you cannot avoid travelling to an area where
yellow fever is found, your doctor should be able to issue you with a certificate
stating that you are exempt from yellow fever vaccination. However, this may
include information on your HIV status, which you may not wish to disclose
to immigration officials. In addition, these waivers are not accepted by all
countries.
You should take care to avoid mosquitoes if you travel to an endemic area
without vaccination. Use mosquito nets, insect repellent that contains DEET,
and avoid areas near standing water where mosquitoes breed.
What about tablets to prevent malaria?
There are a number of treatments available for preventing malaria including
chloroquine (Avloclor/Nivaquine), proguanil (Paludrine) and mefloquine (Lariam).
The type of treatment you will need depends on where you intend to travel,
since the malaria parasite is resistant to some drugs in certain areas. Malaria
prophylaxis is usually recommended for people travelling to parts of Africa,
India, South East Asia, Central and South America.
There is little evidence on the risks of HIV positive people taking these
drugs or interactions with anti-HIV drugs. Currently, it is recommended that
people with HIV take standard preventative malaria treatment, since catching
malaria can be particularly dangerous for people with HIV.
Mefloquine is well known for having unpleasant side effects in some people.
These include sleep disturbances, bad dreams and mood changes, and it is not
recommended for people who have had psychiatric problems in the past, including
depression. These side effects may affect your adherence to your HIV drugs.
Likewise, if you have experienced psychiatric problems in the past, or had
similar side-effects with the HIV drug efavirenz (Sustiva), you may like to
discuss alternatives with your doctor.
Is there anything else to consider?
Traveller’s diarrhoea is a very common problem for people with and without
HIV. In areas where hygiene may be poor, it’s worth taking care to avoid
tap water, undercooked foods and raw fruit and vegetables.
Talk to your doctor or an advisor at your local travel clinic well before
your trip to discuss your options and to organise the appropriate vaccinations
and other treatments you will need. Finally, have a great trip and stay healthy.
• NAM provides information to help you think about your use of HIV treatments,
but this is not intended to replace discussion with your doctor.
