Travelling on HAART, particularly to the US, a 'negative practical and emotional experience.'

Edwin J. Bernard
Published: 27 April 2005

Fear of disclosure to immigration officials and/or travelling companions is leading to a significant minority of HIV-positive tourists on HAART to stop their treatment whilst travelling. This can result in the development of medical problems – including opportunistic infections – frequent holiday curtailment, and an increased risk of drug resistance, according to three presentations at the Eleventh Annual Conference of the British HIV Association with the British Association for Sexual Health and HIV in Dublin.

Two presentations from the Mortimer Market HIV outpatient clinic in Bloomsbury, London, highlighted myriad issues related to travel in general, and particularly travel to countries with HIV entry restrictions. Of the 489 patients asked to participate in the survey, 359 (73%) responded. The majority of respondents were gay white men over the age of 30.

The complexities of travelling on HAART

Three hundred respondents had travelled abroad in the previous two years. Forty-three percent had taken more than two trips abroad during that time, mostly to Europe, but 115 (38%) had visited the US, despite a ban on HIV-positive tourists.

Of the 300 individuals who had travelled abroad, 216 (72%) were taking highly active antiretroviral therapy (HAART) at the time.

Around 26% of the 216 respondents who travelled on HAART reported experiencing HAART-related side-effects prior to travelling, 8% had a worsening of their side-effects on holiday and 2% experienced new side-effects whilst out of the country.

Although 81% reported no change in adherence to HAART, 11% said that they experienced adherence problems whilst travelling. Interestingly, 8% reported better adherence on holiday than at home. Medication storage problems were cited by 14%.

Immigration and customs authorities searched and questioned 15% of respondents at the point of entry, although no-one was refused entry. 81% percent of respondents carried their medication in their hand-luggage, 32% in their suitcase and 6% had mailed HAART to their destination prior to the arrival.

Interrupting HAART whilst travelling

Just under 12% (26 individuals) stopped taking HAART for the duration of their journey, 27% of whom (seven individuals) had a CD4 count of below 200 cells/mm3.

Of the 26 individuals who took a treatment interruption, 54% did not discuss it with their HIV clinician, nurse or pharmacist.

Prior drug resistance was present in 65% of those who took a treatment interruption; 19% were on a triple nucleoside combination, 44% on PI-based HAART and 38% on an NNRTI-based regimen. Due to the long half-life of NNRTIs, the latter put themselves at an increased risk of further drug resistance and possible treatment failure.

When asked why they had taken a treatment interruption whilst travelling, 50% said it was because they were entering a country with HIV visa restrictions and were afraid of being found out and deported. However, 39% also feared that taking HAART would have required unwanted disclosure to travel companions. 23% cited HAART-related side-effects as another reason for temporarily stopping HAART.

The researchers found that interrupting HAART had a clear relationship to ethnic background: 11% of white participants versus 30% of black participants (and 0% of Asian participants) stopped their treatment whilst travelling abroad.

The effects of an unplanned treatment interruption whilst travelling were as follows:

  • 31% interrupters vs. 9% on continued HAART had to end their holiday early due to illness
  • 50% interrupters vs. 29% on continued HAART were unwell abroad
  • 50% interrupters vs. 20% on continued HAART had to see a doctor abroad
  • 62% interrupters vs. 27% on continued HAART needed to see a doctor on return
  • 12% interrupters vs. 0% on continued HAART developed opportunistic infections.

Travelling to the US

A survey of 408 attendees at an HIV treatment clinic in Manchester found that 99 (24%) had travelled to the US since testing HIV-positive, of whom 76% were on HAART at the time of visiting the US. Only 5% had obtained an HIV-specific visa waiver prior to travelling.

Of those on HAART, 10% mailed their medication prior to travel due to concern of border searches and 16% were searched at the border, although no-one was refused entry. Only 47% were able to completely adhere to their HAART whilst in the US, and just under 10% discontinued their therapy without medical advice.

The authors conclude that “many patients reported negative practical and emotional experiences resulting from the travel restrictions.”

References

Mahto M et al. Effects of restrictions to HIV-positive people travelling to the USA Eleventh Annual Conference of the British HIV Association with the British Association for Sexual Health and HIV, Dublin, abstract P139, 2005.

Schuhwerk M et al. Stopping combination therapy whilst travelling: is there a reason for great concern? Eleventh Annual Conference of the British HIV Association with the British Association for Sexual Health and HIV, Dublin, abstract O32, 2005.

Schuhwerk M et al. The complexity of travelling with HAART Eleventh Annual Conference of the British HIV Association with the British Association for Sexual Health and HIV, Dublin, abstract P149, 2005.

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