International AIDS Society-USA

Presentation

HIV-Infection and International Travel: Pretravel Patient Assessment and Management
Carlos Franco-Paredes, MD, MPH

Level: Advanced

You must answer at least 6 of 8 questions correctly (> 75%) to receive a passing score and earn CME credit.

Case for Questions 1 to 8

A 47-year-old woman is planning to visit her family and friends in rural southern India. She has lived in the United States for more than 10 years and received an HIV diagnosis 3 years ago. She is also being treated for a seizure disorder and depression. Owing to nonadherence related to severe adverse effects, she has drug resistant virus and has received numerous antiretroviral regimens. Four weeks ago, she began a new regimen consisting of emtricitabine and tenofovir and ritonavir-boosted darunavir. Her most recent CD4+ cell count is 120/μL and plasma HIV RNA level is above 100,000 copies/mL. She visits your office seeking pretravel advice.

1. Is this patient well enough to travel safely to rural India?

a. No, travel should be deferred until immune reconstitution occurs.

b. Yes, she can now travel safely.

c. No, she should not travel at all.

d. Yes, she can travel safely with further pretravel advice.

2. The case continues.

The patient agrees to delay traveling, and after 6 months on her current antiretroviral regimen, her CD4+ cell count increases to 290/µL and her plasma HIV RNA level decreases to 450 copies/mL. At this point, she reschedules her trip to rural India and, during her next visit with you, requests pretravel advice about vaccines and malaria chemoprophylaxis.

Now that she can travel safely, would you recommend malaria chemoprophylaxis in this patient?

a. No, due to the possibility of drug interactions.

b. No, not for travel to rural India.

c. Yes, it is crucial in this patient, along with counseling about personal protection measures against mosquito bites.

3. What is the antimalarial drug of choice in this patient?

a. Atovaquone/proguanil

b. Doxycycline

c. Mefloquine

d. Chloroquine

e. Quinine

4. Which travel-recommended vaccine requires that the patient delay traveling for 10 days after administration of the vaccine?

a. Measles-mumps-rubella vaccine

b. Combined tetanus, diphtheria, and pertussis vaccine

c. Yellow fever vaccine

d. Inactivated Japanese encephalitis vaccine

e. Cholera vaccine

5. Which of the following is not a live-attenuated vaccine?

a. Measles-mumps-rubella vaccine

b. Combined tetanus, diphtheria, and pertussis vaccine

c. Yellow fever vaccine

d. Ty21a oral typhoid vaccine

e. Bacille Calmette Guérin vaccine.

6. Which preventive measures against typhoid would you recommend to this patient?

a. None, given her level of immunosuppression

b. Ty21a oral typhoid vaccine

c. Typhoid capsular polysaccharide vaccine

d. Quinolone chemoprophylaxis to prevent typhoid fever

7. Should you recommend inactivated trivalent influenza vaccine in this patient?

a. No, inactivated trivalent influenza vaccine is contraindicated in this patient.

b. No, immunization against influenza is unnecessary when traveling to southern India.

c. Yes, influenza risk is year-round in tropical and subtropical regions, and this patient can safely receive inactivated trivalent influenza vaccine.

8. What is your recommendation for hepatitis A virus immunization for this patient?

a. Provide hepatitis A vaccine.

b. Provide hepatitis A vaccine and immunoglobulin.

c. Hepatitis A vaccine is contraindicated in this HIV-infected patient.

d. Check hepatitis A antibody response after hepatitis A vaccination.