Travel-related illnesses – especially diarrhoea, respiratory
complaints and malaria – are common among HIV-positive sub-Saharan African
migrants visiting their countries of origin, according to a study by Dr Thierry
Pistone of CHU Bordeaux, Department for Infectious and Tropical Diseases in
France, and colleagues, published in the online edition of Travel
Medicine and Infectious Disease
. Overall, 38% of individuals experienced at
least one health event during or shortly after travel. Risk factors included a
low-level viral load and not receiving medical advice before departure about
travel-related health risks.

“Because consultation conducted in a specialized pre-travel
clinic was not systematically offered, some participants might have missed
dedicated pre-travel medical advice,” comment the investigators. “Malaria
prophylaxis and travel-related vaccinations are not refunded by the French
Social Security and low awareness of health risks during travel is clearly
recognized among migrants visiting friends and relatives.”

A quarter of HIV-positive people in France are migrants from
sub-Saharan Africa. Excellent responses to antiretroviral therapy mean that
many make frequent and prolonged visits to their countries of origin.

Investigators in France therefore designed a study which aimed
to describe the incidence and type of health problems experienced during and
shortly after travel and to determine their risk factors.

The 264 participants, all of sub-Saharan origin, were
recruited at 24 clinics across France between 2006 and 2009. All were taking
stable antiretroviral therapy and had a viral load below 200 copies/ml (94% had
an undetectable viral load below 50 copies/ml). Individuals taking a trip to a
sub-Saharan country lasting between two weeks and six months were eligible for
inclusion.

Data were collected on the proportion of people who received
pre-travel health advice, especially about the prevention of diarrhoea and
malaria, and the use of anti-malarial prophylaxis. Information was gathered on
the incidence of health problems and their type during travel and within one
month of return to France.

The majority (59%) of participants were female and the
median age was 41 years. Pre-travel CD4 cell counts ranged between 66 to 1600
cells/mm3 (median 439 cells/mm3).

The main reason for travel (89%) was to visit family and
friends. All participants travelled to their country of origin, with 49%
visiting Central Africa and 46% West Africa. The median duration of travel was
five weeks.

Pre-travel advice on diarrhoea and vector-borne disease
(such as malaria) was provided to 92% of people. Just
over half (56%) of participants reported using at least one method to prevent
vector-borne diseases, such as mosquito repellents or bed nets.
Malaria
prophylaxis was provided to 98% of people and two-thirds of individuals
reported being adherent to this medication.

Travel vaccination data were available for 206 people, with
91% vaccinated against yellow fever, 71% for diphtheria-tetanus-polio and 31%
for typhoid fever.

At least one health event was reported in 100 (38%)
migrants, among whom 13 had two events. Among the overall 113 events, 76 (67%)
occurred during travel and 56 (50%) required medical care. 38 (68%) of these
sought medical care during the travel. 45 were outpatient visits, 10
hospitalisations, and 1 was a medical evacuation.

The most common health problems were diarrhoea and
gastrointestinal complaints (26%), respiratory illness (18%) and malaria (15%).

One patient died because of malaria. This patient was a 26-year-old
Nigerian woman whose pre-travel CD4 cell count was 354 cells/mm3.
She showed lack of adherence to her malaria prophylaxis and despite admission
to intensive care died because of acute respiratory distress syndrome.

“The single case of fatal malaria shows the potential
severity of this disease, especially among HIV-infected immunocompromised
individuals, and the need for careful anticipation of travel and tailored
counselling to include relevant advice on malaria prophylaxis,” comment the
authors.

The main risk-factors for travel-related health events were a
viral load between 50 copies/ml and 200 copies/ml (aOR = 4.31; 95% CI,
1.41-13.1) and lack of pre-travel medical advice (aOR = 3.62; 95% CI,
1.38-9.470.

A malarial fever or unspecified fever was strongly
associated with lack of pre-travel advice regarding diarrhoea and vector-borne
infections (aOR = 4.60; 95% CI, 1.24-17.1).

“Our results highlight the need to tailor counselling
towards adherence to pre-travel medical advice regarding diarrhoea and
vector-borne diseases prophylactic measures,” conclude the authors. “If an
earlier pre-travel counselling is tailored, HIV-infected migrants could
maintain a sustainable undetectable HIV plasma viral load, and thus minimize the
risk of travel-related health events… A specific education program directed
towards HIV-infected sub-Saharan migrants visiting their native country could
help to achieve these goals.”