Guide for Aviation Medical Examiners
Disease Protocols - History of Human Immunodeficiency Virus (HIV) Related Conditions
Persons on antiretroviral medication will be considered only if the medication is approved by the U.S. Food and Drug Administration and is used in accordance with an acceptable drug therapy protocol. Acceptable protocols are cited in Guidelines for the Use of Antiretroviral Agents in HIV Infected Adults and Adolescents developed by the Department of Health and Human Services Panel on Clinical Practices for Treatment of HIV Infection.
For persons taking HIV medication for long-term prevention or Pre-Exposure Prophylaxis (PrEP), see Item 48. General Systemic - Human Immunodeficiency Virus (HIV).
Application for special issuance must include reports of examination by a physician knowledgeable in the treatment of HIV infected persons and a medical history emphasizing symptoms and treatment referable to the immune and neurologic system. In addition, these reports must include a "viral load" determination by polymerase chain reaction (PCR), CD4+ lymphocyte count, a complete blood count, and the results of liver function tests. An assessment of cognitive function (preferably by Cogscreen or other test battery acceptable to the Federal Air Surgeon) must be submitted. Additional cognitive function tests may be required as indicated by results of the cognitive tests. At the time of initial application, viral load must not exceed 1,000 copies per milliliter of plasma, and cognitive testing must show no significant deficit(s) that would preclude the safe performance of airman duties.
Application for special issuance must include reports of examination by a physician knowledgeable in the treatment of HIV-infected persons and a medical history emphasizing symptoms and treatment referable to the immune and neurologic system. For initial consideration, see the Human Immunodeficiency Virus (HIV) Specification Sheet (PDF) for the required clinical reports and documentation (including cognitive testing).
If granted Authorization for Special Issuance, follow-up requirements will be specified in the Authorization letter. However, the usual requirements will be:
- First 2 years of surveillance: see the Under 2 Year Surveillance HIV Specification Sheet (PDF)
- After the first 2 years of surveillance: see the After 2 Years Surveillance HIV Specification Sheet (PDF)