Increased risk of wasting syndrome in HIV-infected travellers: prospective multicentre study

HIV-infected patients from moderate regions who travel in tropical countries may experience clinical disease progression due to exposure to bacteria (including mycobacteria), fungi and parasites. In the Swiss HIV Cohort Study we examined the hypothesis that travelling increases the risk of tuberculosis, wasting syndrome, cryptosporidiosis, isosporiasis, cryptococcosis, coccidiomycosis, histoplasmosis and Salmonella septicaemia. A total of 4549 participants were included (in 1988-98) of whom 596 (13.1%) travelled at least once. During 16,800 person-years of follow-up 231 patients developed at least 1 of the diseases of interest. Wasting syndrome was the only diagnosis significantly associated with travelling (hazard ratio 2.16, 95% confidence interval 1.09 to 4.30). The risk of wasting syndrome ('slim disease') should be taken into account when counselling HIV-infected patients intending to travel in tropical regions.