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b) Table 2 — Applicants established on combination antiretroviral therapy (cART)
CD4 Count > 350 = 0 201 − 350 = +0.62 51 − 200 = +1.46 ≤50 = +2.44
BMI ≤ 18 = +0.80 18.1 − 25 = 0 > 25 = −0.29
Viral Load < 500 = 0 ≥ 500 = +0.18
CD4 slope (3 month) < −25/mm3 = +0.49 −25 to +25/mm3 = 0 > 25/mm3 = +0.18
Anaemia No = 0
Hb > 14.0g/dL male
Hb > 12.0g/dL
female
Mild = +0.68
Hb 8.01 − 14.0g/dl male
Hb 8.01 − 12.0g/dl female
Severe = +1.02
Hb ≤ 8.0g/dl
ART experience prior to
cART
Yes = 0 No = −0.39
Taking antiretrovirals Yes = 0 No = +1.24
Age Age × 0.027
Infected with HIV Via intravenous drug use = +0.25 Via any other route = 0
Prior diagnosis of AIDS
at starting cART
No = 0 Yes = +0.19
Score % Risk of clinical progression in following twelve months
<1.5 0.5
1.5 – 2.99 1.4
3.0 – 4.49 6.3
≥4.5 20
ICAO Preliminary Unedited Version — November 2009 III-13A-3
Table 2 enables a risk assessment to be undertaken. The figures are summated to reach a
score that allows a prediction of risk of progression during the next 12 months.
Notes:
Acceptable medications include: abacavir, didanosine, emtricitabine, lamivudine, tenofovir, zidovudine,
atazanavir, fosamprenavir, lopinavir/ ritonavir, nelfinavir, saquinavir, nevirapine and efavirenz
Unacceptable medications include enfuvirtide, zalcitabine, indinavir and stavudine.
Recently available medication, e.g. tipranavir, darunavir, raltegravir and maraviroc, may be acceptable on
an individual basis. Particular attention needs to be given to the toxicity and side-effect profile of such
medications.
A “temporary unfit” assessment should be made when initiating, modifying or discontinuing ART. When
stable, recertification after three months of monitoring may be permitted providing that there has been an
acceptable serological response, no ongoing side-effects and full blood count (FBC), liver function tests
(LFTs), lipids and fasting blood glucose are acceptable.
Those commencing or modifying efavirenz treatment require a psychiatric and neurological examination
at initial certification or within six months after initiating therapy.
Reviews should take account of any over-the-counter medications and alternative therapies being taken
3. Follow-up
Regular follow-up is required, to include:
• 3 monthly CD4* and viral load measurements
• 6 monthly neurological assessment (by HIV specialist or neurologist including consideration
of the need for psychiatric evaluation)
• if taking ART: 6-monthly LFTs, FBC, lipids and fasting glucose.
• Annual cognitive function assessment
– Evidence of having passed a Licence Proficiency Check (LPC) or the report from a
medical flight test (MFT) with a Flight Instructor Examiner (FIE) may be considered in
lieu of this where disease stability and the risk of disease progression is acceptable.
Impaired performance will require further neuropsychological assessment to be compared
with baseline testing and any deficits will require that the pilot is declared temporarily
unfit. Neuropsychological assessment should be undertaken if there are any clinical
concerns about cognitive impairment.
Further co-infection testing should be undertaken where clinically indicated and those with new
positive tests must be deferred for further evaluation.
If an applicant develops new symptoms and/or fails to achieve the nominal levels listed above he
must be declared temporarily unfit and referred to the Licensing Authority.
ICAO Preliminary Unedited Version — November 2009 III-13A-4
REFERENCES
1. Table 1 is derived from Phillips A. CASCADE Collaboration. Short-term risk of AIDS according
to current CD4 cell count and viral load in antiretroviral drug-naive individuals and those treated
in the monotherapy era. AIDS 2004 Jan 2. 18(1):51-8 and from the WHO guidelines on initiating
ART.
2. Table 2 is derived from Mocroft A, Ledergerber B, Zilmer K, Kirk O, Hirschel B, Viard J-P,
Reiss P, Francioli P, Lazzarin A, Machala L, Phillips A, Lundgren J; for the EuroSIDA study
group and the Swiss HIV Cohort Study Short-term clinical disease progression in HIV-1-positive
patients taking combination antiretroviral therapy: the EuroSIDA risk-score. AIDS. 21(14):1867-
1875, September 2007.
————————
ICAO Preliminary Unedited Version — November 2009
PART III
Chapter 14. HAZARDS OF MEDICATION AND DRUGS
Page
Introduction ............................................................................................................ III-14-1
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Manual of Civil Aviation Medicine 2(100)
