Following diagnosis or on declaration of HIV infection, the pilot should be declared unfit or certificate issue deferred until reports have been obtained from the reviews described in (a) to (e) below. These can be used to assess functional fitness and the prospective incapacitation risk.
(a) HIV Specialist Review - An accredited specialist in Genitourinary/HIV medicine should undertake this review. The report submitted should include:
(b) Neurology Review
Assessment should be undertaken to look for neurological sequelae either of HIV positivity or therapy by an HIV specialist or consultant neurologist.
(d) Psychiatry Review (if clinically indicated)
Assessment should be undertaken by a consultant psychiatrist with particular attention paid to the psychiatric symptoms and signs related to HIV seropositivity and or Anti Retroviral Therapy (ART). There is evidence in the immediate post diagnosis phase of a higher risk of developing a depressive illness. Some medication may also have side-effects such as mood changes and/or depressive illness. An initial assessment of these conditions can be made by the treating HIV specialist with a further assessment by a psychiatrist if indicated.
(e) Cardiology Review (if clinically indicated)
Lipodystrophy and metabolic syndrome may arise as an interaction between HIV disease and or immune recovery and ART. This may manifest as a dyslipidaemia with raised total cholesterol, low HDL cholesterol and raised Triglycerides or insulin resistance and hyperglycaemia. Cardiology review is required in the presence of significant cardiac risk factors e.g.:
Pilots whose condition is stable, asymptomatic, with an acceptable CD4+ count and viral load (assessed using data from CASCADE Collaboration/EuroSIDA), with acceptable co-infection serology and therefore an acceptable risk of disease progression may be considered for a Class 1 with an Operational Multi-pilot Limitation. These applicants should be referred to the AMS. Class 2 applicants who are similarly well and have an acceptable risk of disease progression can be considered in consultation with the AMS.
As a guide the following are generally acceptable medications providing the applicant has no ongoing side-effects and their FBC, LFTs, lipids and fasting glucose are acceptable:
Certificate holders should be declared unfit whilst initiating, modifying or discontinuing ART and may be reassessed after a period of 2 months, although in some cases it may be at least 6 months before recertification, by means of a report from their treating HIV specialist, to include recent
CD4+ counts and viral loads and confirmation of an absence of ongoing side-effects from medication or symptoms related to HIV seropositivity.
Further co-infection testing will be required as clinically indicated, and those with positive tests need to be referred to the AMS in the case of Class 1 certificate holders or assessed in consultation with the AMS in the case of Class 2 certificate holders.
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