Developed in collaboration with CASA Medical.
Pre-exposure prophylaxis (PrEP) is a highly effective method of human immunodeficiency virus (HIV) prevention using HIV medications. It is 99% effective if used correctly.
This guideline refers to PrEP treatments that include:
- Regular daily dosing regimen with tenofovir disoproxil/emtricitabine (TD/FTC)
- “On-demand” dosing with TD/FTC
- Injectable long-acting cabotegravir (CAB-LA)
“Start-up syndrome” (headache, weight loss /weight gain, fatigue and gastrointestinal upset) is the most common safety relevant problem on commencement of therapy and usually resolves within the first month of taking PrEP.
Ongoing regular review with a treating health professional is required. This is typically two monthly with CAB-LA and three monthly with TD/TFC PrEP.
Pilot and controller information
- Pilots or controllers must cease flying or operating on commencement of PrEP for a minimum period of 2 weeks to assess medication suitability and side effects.
- Pilots and controllers should contact their ME or CAA AvMed when starting PrEP.
- The occurrence of any safety relevant side effects or abnormal testing results will require cessation from flying or operating and review by a ME.
Aeromedical relevance and implications
- The effect of treatment on the aviation task
- Acute Incapacitation due to medication side effects on starting treatment – eg. vomiting.
- Subtle incapacitation due to medication side effects on starting treatment – eg. headache, or the occurrence of side effects such as nephrotoxicity or hepatotoxicity.
- The effect of aviation (task and environment) for treatment: Nil
List of information that should be provided to ME.
Initial
- Report from the treating health professional including-
- Confirming PrEP treatment type and the presence of any adverse effects
- Baseline HIV test, hepatitis A, B, C, and syphilis serology, eGFR for TD/TFC PreP
- Baseline HIV test, hepatitis A, B, C, and syphilis serology, eGFR and LFTs CAB-LA PreP
- Recommended ongoing clinical review, vaccinations eg Hepatitis A or B, and serology testing
Ongoing surveillance requirements
- TD/TFC PrEP - three-monthly clinical review and HIV testing and eGFR (at 3 months after starting PrEP and then 6 monthly).
- CAB- LA – initial clinical review at one month after starting PrEP and then two monthly with HIV testing, eGFR, and LFTs
Renewal
At renewal medicals, copy of surveillance visits and test results since last medical will be required:
- HIV serology and eGFR
- LFTs for CAB-LA PrEP
ME aeromedical decision guide
If ALL the criteria in the table below the ME may proceed with medical certification. Evidence supporting the ME’s decision (for example reports and results) must be sent to CAA AvMed.
| ME must confirm |
Tick |
| All clinical reports reviewed |
|
| Pilot or controller is well |
|
| Negative HIV serology within the last 3 months |
|
| Other serology negative for Hep A, B, C or syphilis infection |
|
No side effects from PrEP treatment
Normal renal function tests
Normal LFTs (CAB-LA) |
|
| Regular reviews with treating GP or specialist |
|
| ME considers safe to certify |
|
An AMC referral to CAA AvMed is required if a pilot’s or controller’s condition does not meet all the above criteria and they consent to their condition being considered under flexibility to the CAR 67 rules.
ME letters
HIV-PrEP medical certificate letter [DOCX 21 KB]
