Ethnicity predicts viral rebound after travel to the tropics in HIV-infected travellers to the tropics in the Swiss HIV Cohort Study. HIV Medicine
Gebreselassie et al. aimed to describe the characteristics of the population in the Swiss HIV Cohort Study (SHCS) travelling to the tropics and to determine the frequency and risk factors of viral rebound following a travel episode vs. a nontravel episode if the viral load at the beginning of the episode was suppressed.
There were 6’084 (36.5%) patients who had ever travelled to the tropics. Travel frequency increased over time, with travellers having a less advanced median clinical Centers for Disease Control and Prevention stage and a higher median CD4 count nadir than nontravellers. Viral rebound was not more common in travel episodes than in nontravel episodes. Evident risk factors for viral rebound after travel were being of sub-Saharan African origin, current intravenous drug use, being younger, having a lower CD4 count, a history of antiretroviral therapy (ART) failure, using nonrobust ART, and demonstrating poor overall adherence. Among the 477 post-travel viral rebounds, 44% of the resistance tests showed new resistance mutations.
In conclusion, travelling was not per se a risk factor for loss of viral control. However, sub-Saharan African HIV-positive travellers were at highest risk of viral rebound even in nontravel episodes, but especially in travel episodes. Thus, pre-travel adherence counselling should focus on patients of sub-Saharan African origin.