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TRAVELING
Dec 2, 2011

Hi Doctor , My CD4 759 and I am waiting for the VL results to get back, I am traveling to my country (Cuba) and I would like to know if you think is ok for me to do it. This is the first labs results after started treatment , I saw someone else with a similar question but I need to know what do you think about Cuba, Do you think is safe to go there?? I have others HIV + friends that went and they say that its ok but I would like to know your opinion. Thank You :)

Response from Dr. Young

Hello and thanks for posting.

I have asked my HIV clinic partner and travel medicine expert (from Global Travel Health, Denver), Dr. John Hammer to answer your questions:

Thanks for the question! Too many people (with and without HIV infection or other risks) travel to Cuba or other international destinations without getting advice regarding health risks. With a CD4 count of 759 and a viral load that is hopefully headed toward undetectable your ability to fight infections should be pretty close to normal and Cuba, in the grand scheme of international destinations, is a pretty safe place. Having said that there are associated risks with this trip (in any traveler) that can be avoided:

First of all you should make sure that you've been vaccinated for Hepatitis A and B. Hepatitis A is generally transmitted by ingesting contaminated food and water but can be sexually transmitted as well. Hepatitis B is transmitted by sexual contact, needle sharing or blood transfusion. Vaccination for both of these viruses is standard in the HIV-infected population (and much of the general population) so hopefully you've received at least one Hep A vaccine and the 3 shot series for Hep B (some providers might double the dose for Hep B vaccine in HIV-infected individuals). There is a blood test to confirm response to these vaccines that your provider can easily order if there's a question of adequate response.

Typhoid vaccine might also be useful in this setting (Salmonella typhi is transmitted by ingestion of contaminated food/water). We generally use the injectable killed vaccine as opposed the the live oral vaccine in our HIV-infected travelers as it minimizes any risk of vaccine-associated illness.

You should make sure that you're up to date with both your pneumococcal vaccine and flu vaccine (both standard in HIV-infected individuals) along with tetanus (Tdap). All these will serve you well after your trip as well.

Rabies is endemic in Cuba (humans are generally exposed via dog bites) and is seen even in Havana. If you might not be able to avoid dogs (and their bites) or might be in rural areas without access to medical care, the 3 shot rabies vaccination may be considered. While it is expensive (generally over $200 per shot) it is generally well tolerated and might be worthwhile as rabies infection is pretty much always fatal. Admittedly, most of our patients decide to try to avoid dog exposure.

Traveler's diarrhea certainly occurs in Cuba - a prescription for loperamide (Lomotil) or over the counter Immodium along with Cipro (500 mg twice daily) to be taken at the onset of diarrhea and for 3 days as needed should be in your travel kit (I never travel without these).

Fortunately there is no malaria in Cuba.

Finally, enjoy your trip - Cuba is reportedly a fascinating place - and please remember to practice safe sex if that might be a factor. There are a host of sexually transmitted diseases out there that only a condom might prevent. Bon Voyage!

JH



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