HIV /AIDS

Introduction

HIV seropositive pilots using antiviral medications are not considered eligible for any class of medical certificate under the “General Medical Condition” clauses of FAR 67.113, .213 and .312, paragraphs (b) and (c) per Federal Air Surgeon policy. However, many HIV+ pilots using antiviral medication may hold FAA medical certificates under the Special Issuance provisions of FAR Part 67.401.

History

In 1997, the Federal Air Surgeon changed the FAA policy on grounding all pilots/controllers with AIDS (Acquired Immunodeficiency Syndrome) and those HIV positive pilots/controllers using anti-viral medications after considerable debate and review of the scientific literature. The main area of concern dictating past and current policy centers on the potential for neurocognitive impairment due to HIV, AIDS dementia or the medications used to treat the condition, any of which could compromise a individual’s ability to safely operate in the aviation environment.

The policy allows granting a Special Issuance Authorization to some previously disqualified pilots in these categories. Each case must be reviewed individually. The first pilot using medications for HIV/AIDS was certified by the Federal Air Surgeon in November 1997. Since then, many of pilots have applied and been certified under the Special Issuance provisions of FAR Part 67.401. AMAS physicians have represented many of these cases with the FAA.

In the past, HIV positive pilots have been allowed to fly with a standard medical certificate as long as they were asymptomatic and were not taking anti-viral medications (including protease inhibitors). Recent advances in the treatment of HIV leads many physicians to treat asymptomatic patients with medication early in the condition. The goal is to reduce the likelihood of progression to AIDS and to lengthen the disease free state. This early treatment is now the standard for medical care.

Current FAA Policy on HIV Seropositivity

Those pilots who are HIV positive or are currently asymptomatic following recovery from an AIDS-defining illness may be certified if they meet certain conditions. They must be taking FDA approved medications used in accordance with the “Guidelines for the Use of Antiretroviral Agents in HIV-Infected Adults and Adolescents ” and tolerate these medications well. HIV viral load should be less than 1,000 copies/ml by PCR. CD4+ counts should be stable. Laboratory studies should be near normal and the pilot should be under the regular care of a physician experienced in treating HIV and AIDS.

In a 2003 policy change, the FAA now will allow pilots with a history of any AIDS defining illness (AIDS-DI) to hold a Special Issuance. A history of PCP as an initial presentation of HIV disease was first granted a Special Issuance by the Federal Air Surgeon in October 2000. Prophylactic medications for suppression of opportunistic infections are permissible. The certification criteria for an AIDS-DI are some what more stringent than for pilots who are only HIV-positive. (See chart below)

The pilot will also be required to undergo regular testing for neurocognitive function compared to other aviators. Cognitive testing by the CogScreen®-Aeromedical Edition is strongly preferred although a battery of alternate tests is acceptable if the CogScreen is not available. If the test results are satisfactory, the pilot may be granted a Special Issuance Authorization valid for a limited period (6 months to one year). Continued certification is contingent on stability of the condition and repeat testing. After two years of stability, the FAA reduces the follow up requirements. Neurocognitive testing is required annually for ATCs, First and Second Class certification, and typically every two years for Third Class certification.

The current FAA protocol for certification of HIV positive pilots remains flexible and requirements may be added or deleted from those listed below. Each case is considered individually. The current policy requires:

• * Viral load by PCR on two consecutive test at least one month apart
• ** Viral loads done at least quarterly
• # AIDS defining illnesses resolved at least 6 months
• ## Stable CD4+ count (> 200, see above for viral load)
• ## Complete Blood Count (CBC)
• ## Liver Function Tests (LFTs)
• ## Renal Function Tests (Kidneys)
• @ “Normal” neurocognitive function testing, CogScreen AE is preferred;
• Required annually for 1st and 2nd Class, every 2 years for 3rd Class
• @@ If CMV retinitis is present, a full ophthalmologic exam with visual fields is required initially and every 6 months
• Using FDA approved medications by Acceptable Protocol
• Tolerate medications well without major side effects
• Under the care of physician experienced in HIV treatment
• No other disqualifying conditions or medication

Note that the frequency of above testing is typically reduced after two years of stable monitoring by the FAA.

Administrative Procedures

Initial Special Issuance Authorizations for HIV controlled with medication are granted by the the Aeromedical Certification Division or the Regional Flight Surgeons’ offices. Renewals of SIAs, if there has been no adverse changes in clinical status, are granted by the both the Regional Flight Surgeon’s office and the Aeromedical Certification Division (AMCD) in Oklahoma City. This is usually a faster process if all appropriate information is included in the package and forwarded to the FAA in a timely basis.

AMAS Waiver Assistance

AMAS encourages all pilots to seek the optimum medical treatment for whatever condition afflicts them. We also strongly encourage full disclosure and honest reporting to the FAA of treatment for medical conditions. We will assist pilots with questions regarding the optimum way to report treatment for HIV and all medical conditions. Contact us through our Confidential Questionnaire.