Acquired Immunodeficiency Syndrome (AIDS)

Description

AIDS is a serious disease, first recognized as a distinct syndrome in 1981. This syndrome represents the late clinical state of infection with the human Immunodeficiency virus (HIV), resulting in progressive damage to the immune system and in life-threatening infectious and noninfectious complications.

Occurrence

AIDS and HIV infection occur worldwide. Comprehensive surveillance systems are lacking in many countries, so the true number of cases is likely to be far greater than the numbers officially reported, particularly from developing nations. The Joint United Nations Programme on HIV/AIDS (UNAIDS) estimates that 34.3 million people are HIV-infected worldwide. Because HIV infection and AIDS are globally distributed, the risk to international travelers is determined less by their geographic destination than by their sexual and drug-using behaviors.

Risk for Travelers

The risk of HIV infection for international travelers is generally low. Factors to consider when assessing risk include the extent of direct contact with blood or secretions and of sexual contact with potentially infected people. In addition, the blood supply in developing countries might not be adequately screened.

Preventive Measures

No vaccine is available to prevent infection with HIV. For information on the safety of vaccines for HIV-infected people, see Vaccine Recommendations for Travelers With Altered Immunocompetence, Including HIV.

Travelers should be advised that HIV infection is preventable. HIV is transmitted through sexual intercourse and needle- or syringe-sharing; by medical use of blood, blood components, or organ or tissue transplantation; and perinatally from an infected woman to her infant. HIV is not transmitted through casual contact; air, food, or water routes; contact with inanimate objects; or mosquitoes or other arthropod vectors. The use of any public conveyance (for example, an airplane, an automobile, a boat, a bus, or a train) by people with AIDS or HIV infection does not pose a risk of infection for the crew members or other travelers.

Travelers should be advised that they are at risk if they:
Have sexual intercourse (heterosexual or homosexual) with an infected person.
Use or allow the use of contaminated, unsterilized syringes or needles for any injections or other skin-piercing procedures, including acupuncture, use of illicit drugs, steroid or vitamin injections, medical or dental procedures, ear or body piercing, or tattooing.
Use infected blood, blood components, or clotting factor concentrates. HIV infection by this route is rare in those countries or cities where donated blood and plasma are screened for HIV antibody.

Travelers should be advised to avoid sexual encounters with people who are infected with HIV or whose HIV infection status is unknown. This includes avoiding sexual activity with intravenous drug users and people with multiple sexual partners, such as male or female sex workers. Condoms, when used consistently and correctly, prevent transmission of HIV. Travelers who engage in vaginal, anal, or oral-genital intercourse with anyone who is infected with HIV or whose infection status is unknown should use a latex condom. For those who are sensitive to latex, polyurethane or other plastic condoms are available. (Travelers should be advised to look for the words "for the prevention of disease" on the condom packaging.)

In many countries, needle sharing by intravenous drug users is a major source of HIV transmission and other infections, such as hepatitis B (HBV) and hepatitis C (HCV). Travelers should be advised not to use drugs intravenously or share needles for any purpose.

In the United States, Australia, New Zealand, Canada, Japan, and western European countries, the risk of transfusion-associated HIV infection has been virtually eliminated through required testing of all donated blood for antibody to HIV. In the United States, donations of blood and plasma must be screened for HIV-1 and HIV-2 antibodies and HIV-1 p24 antigen.

If produced in the United States according to U.S. Food and Drug Administration-approved procedures, immune globulin preparations (such as those used for the prevention of hepatitis A (HAV) and HBV) and HBV vaccines undergo processes that are known to inactivate HIV; therefore, these products should be used as indicated. Less developed nations might not have a formal program for testing blood or biological products for antibody to HIV. In those countries, travelers should (when medically prudent) avoid use of unscreened blood-clotting factor concentrates or those of uncertain purity. If transfusion is necessary, the blood should be tested, if at all possible, for HIV antibody by appropriately trained laboratory technicians using a reliable test. (See WHO Blood Transfusion Guidelines for International Travelers for additional information.)

Needles used to draw blood or administer injections should be sterile, preferably single use and disposable, and prepackaged in a sealed container. Travelers with insulin-dependent diabetes or hemophilia, or who require routine or frequent injections should be advised to carry a supply of syringes, needles, and disinfectant swabs (for example, alcohol wipes) sufficient to last their entire stay abroad.

International travelers should be advised that some countries serologically screen incoming travelers (primarily those planning extended visits, such as for work or study) and deny entry to people with AIDS and those whose test results indicate infection with HIV. People intending to visit a country for a substantial period or to work or study abroad should be informed of the policies and requirements of the particular country. This information is usually available from the consular officials of the individual nations. An unofficial list that has been compiled by the U.S. Department of State can be found at the following Internet address: http://travel.state.gov/law/info/info_621.html.

Further information is available from 1-800-342-AIDS, toll free from the United States or its territories (for Spanish-speaking callers, 1-800-344-SIDA, or for hearing-impaired callers with teletype equipment, 1-800-AIDS-TTY).

© Center for Disease Control

Credits: National Center for Infectious Disease