HIV & The FAA

  • Thread starter BayAreaFlyerNewPilot
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BayAreaFlyerNewPilot

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Hi Everyone!

As a new student pilot, I'm going through the motions of obtaining 3rd Class Medical.

Must I report my HIV status? (Undetectable Viral Load).

If I do report my status and meds, what hoops/documentation will I have to jump through?

I'm not looking to be deceitful, but this is a very very personal subject with a lot stigmatism floating around it....

Thanks for your support,friends!
 
https://www.faa.gov/about/office_or...ices/aam/ame/guide/dec_cons/disease_prot/hiv/

Best bet, find a knowledgeable AME and consult - do not fill out MedXpress, do not go in for Class 3, only a consult. No need to mention why, just an appt for consult. If they refuse to do a consult, go to the next AME on the list.

Calling Dr Bruce or (my apologies) I don't remember name of the other AME hanging out here (west coast)
 
Doc Bruce will be able to give you good advice, i think he's still on this board. Best of luck to you!
 
mryan75 said:
Doc Bruce will be able to give you good advice, i think he's still on this board. Best of luck to you!
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@bbchien

Dr. Bruce is still participating... but of late he's been a bit silent on this and a few other forums. My guess is either on vacation, overwhelmingly busy working with other airmen, or walking some hallways in DC on a mission to advocate for GA.

if the OP wants a more immediate answer, then visit the "How to Start" page on www.aeromedicaldoc.com
 
As far as the OP's original question....

BayAreaFlyerNewPilot said:
Must I report my HIV status? (Undetectable Viral Load).
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I am going to say yes to reporting HIV

I think this is going to fall under Question 18X on the 8500-8 form, Application for Airman Medical Certificate. My guess that being diagnosed as HIV positive definitely falls under the Medical History preamble of "HAVE YOU EVER IN YOUR LIFE BEN DIAGNOSED WITH, OR DO YOU PRESENTLY HAVE ANY OF THE FOLLOWING?"

So the OP would mark Yes to 18x, then use the explanations box to add additional detail.

Possibly mark 18u as Yes if any hospital admission was involved with the HIV condition.


From the document that Murphey linked, the OP should know...
  • HIV Positive will be a Special Issuance (SI)
  • Application for special issuance must include reports of examination by a physician knowledgeable in the treatment of HIV infected persons and they must provide a medical history emphasizing symptoms and treatment referable to the immune and neurologic system.
  • 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.
    • BUN and Creatine levels
  • An assessment of cognitive function (preferably by Cogscreen AE [Aeromedical Edition] 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.
The specification sheet for Human Immunodeficiency Virus (HIV) Specification Sheet (PDF) has additional information the OP should be aware of, including
  • Persons who are infected with the HIV and who do not have a diagnosis of Acquired Immunodeficiency Syndrome (AIDS) may be considered for any class medical certificate, if otherwise qualified.
  • Persons on an 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.
  • Current studies should be submitted no later than 30-days from test date.
 
AggieMike88 said:
  • An assessment of cognitive function (preferably by Cogscreen AE [Aeromedical Edition] 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.
Click to expand...

I'm curious - why is this relevant for a HIV positive airman?
 
mtuomi said:
I'm curious - why is this relevant for a HIV positive airman?
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Like Bill said, because it's the FAA and they wrote that document/specification.

Not sure what is being searched for.
 
yes you legally have to report. Neurocog testing is required as medications taken to reduce viral load can affect cognition. If you pas the psychiatric and neurocog testing you will likely be issued a medical ... but neurocog testing likely will be required yearly as part of SI that will be with your medical as long as you have fly.
 
For third class airmen, the neuro cog is every 2- yearly.

If you give any thought to nonreporting, just remember the meds have a huge insurance footprint that can be seen. Lying isn’t received well by the agency.
 
mtuomi said:
I'm curious - why is this relevant for a HIV positive airman?
Click to expand...

Google tells me it is because there is a specific cognitive dysfunction associated with HIV called “HIV-associated neurocognitive disorder”. So there has to be a check for it.
 
Let me ask this....

How does the FAA feel about "amending" your submitted MedExpress. If I change all meds/go through the process (CogScreen) (talk to my AME) PRIOR to being issued the medical, will they just roll with it or will there be consequences.

I honestly had NO idea the medical was this big of a deal...

My flight school NEVER made a bid deal/information about getting a medial.

Thanks again, friends!
 
BayAreaFlyerNewPilot said:
Let me ask this....

How does the FAA feel about "amending" your submitted MedExpress.
Click to expand...

If you have already pressed the submit button and were shown the completed form including the confirmation number at the bottom of page . . . . you cannot go back and update or amend that submission.

So if you are hinting at that version did not include details about your HIV status, medications, and/or doctor visits about HIV, then what you can do is to start a new MedXpress form. This will require using a different email address as the system only allows one completed form per email address per 60 day time period.

If I change all meds/go through the process (CogScreen) (talk to my AME) PRIOR to being issued the medical, will they just roll with it or will there be consequences.
Click to expand...

My suggestion is to do a consultation visit with an AME who has a successful track record of getting HIV applicants approved. See https://tinyurl.com/ame-consult for specific details on doing an AME consult. Specifically items 2, 3, and 4.

During this visit, I suggest discussing what are the various steps required for success, such as
  • what is needed from your doctor treating you for HIV besides the lab results, such as a status letter. And what info needs to be in that letter
  • How quickly after the labs are done do you need to send them into the FAA medical system
  • Are the items in the speciation sheet to be done before your official exam (such as the Cogscreen) or after?
  • Can the AME recommend doctors to accomplish the various steps.
  • Once you bring all of these items to the AME and do the live exam, what happens next? Office issuance or deferral to FAA Medical? If deferral, how long until the FAA gets to your submission and takes action?
  • Since this is likely to result in a Special Issuance, what are the requirements to comply with the SI?
  • Is this AME willing to act as your advocate and personally deal with the FAA should anything get snarled up in channels? (Hint: if he says no, this may not be the best AME choice. A yes answer could mean you found the right guy to manage your case)
Again, this first visit is a consultation, info gathering, and educational activity only. No live exam where you surrender the MedXpress confirmation number.

If the AME insists you surrender the number before he will talk with you, remind him that this is a consultation and you are not required to surrender the confirmation number just to discuss the what's and hows of the process. If he continues to demand the number, leave and find someone else.

Once you're 100% clear on what items are required, then get busy getting them done. And once you have gathered them all up, I strongly suggest repeating the consultation visit with the objective of reviewing the items you have gathered to ensure all required items are in the packet, properly formatted, and sequenced. Getting it done in one is the objective. If an item is missing or done wrong, you want to know before the official exam.

If the AME says it is all there, and nothing else is needed, and phased on a quick physical exam you have very high chances of being issued your medical certificate, then, AND ONLY then surrender the confirmation number and have the live exam performed.

I honestly had NO idea the medical was this big of a deal...

My flight school NEVER made a bid deal/information about getting a medial.
Click to expand...
The medical is a significant requirement to obtain and retain the keys to aviation. And many times, it's for good reason to protect the pilot, the passengers in his care, and the public on the ground.

It is unfortunate that you school and instructor issued the mark on discussing medical certification with you. But I am not surprised. Schools and instructors often are more focused on generating income by getting you in the air than sitting down at hour one to review if you are medically eligible to continue beyond solo.

Weave had many threads on "when should instructors discuss medical certification?" And I think those here agree that doing it early on provides the best service to the student.


Hopefully this post helps. Continue to ask questions as you think of them. And keep us in the loop as your journey progresses.
 
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How do they feel? A great big bag of Nope, Not Ever, No Way to changes. Once you submit your medical, it is set. If you have a mistake on it, let it sit 90 days (correct?) and it will get purged as "not used". After purging you can put it in correctly.

If you have a MedExpress application and you've given the number to an AME at your exam, then it goes live. Once live, you can only move forward - whatever it says on the exam has to be dealt with.

General advice - it's an open book test and you know all the questions. Get a consult with the AME before you go live. You should never go into a medical exam without knowing the outcome ahead of time. A great AME can even "pre-wire" your exam with the FAA so that you know ahead of time what will be required. Then you arrive at their office with all your testing results in hand and submit them as part of your package. You still get a deferral, but everything the FAA wants is already done and it expedites your medical.
 
The key is whether you had the exam or not. If you had the exam and got a medical then you probably need a lawyer if you lied. If you have not had the exam, my understanding is that the form just goes away after a number of months. You can do a new form under a different email, be honest, it's not worth it, you'll get caught if you lie.
 
As I understand it, the AME can make changes to your MedXPress form - once the exam goes live (i.e., once the confirmation number is entered into the system by the AME). So I don't think you necessarily need to scrap a submission that contains errors, as long as you disclose EVERYTHING to the AME prior to the exam, and given that information, you and the AME agree to take the exam live.

But by all means, arrange for a consultation first, and make sure that the AME does not enter the confirmation number into the system until you have decided to commit to the process at this time. If more information or further tests are needed, it is better to not go ahead with the actual exam until those tests are completed and the AME is satisfied that you will be issued.

And if those tests will take more than 60 days (I think), your MedXPress with its errors will vanish anyway, so no harm done.

All this assumes that you didn't already do the exam with the problem MedXPress and fail to disclose the items that were left off. That's a different ball of wax, as others have said.
 
With regards to finding the right AME....

If you cannot find the right guy within a reasonable travel distance, then I highly suggest hiring Dr. Bruce Chien in Bolingbrook, IL to be your AME.

Yes it is a long distance, but you will be working with one of the best in the nation when it comes to challenging cases requiring lots of steps.

And Dr. Bruce is the one who taught us "consult first, clear the deck of obstructions, and only then do the live exam".

Read the recent thread started by Cogscreamer about his positive experience with Dr. Bruce as he sought certification while remaining on an SSRI.
 
Thanks everyone for the support! Its a headache to navigate the system; all insight has been appreciate...

1. I did submit my MedExpress to the AME, but it was kicked back for further review due to a DUI 7 years ago. That'll put me with a HIMS AME and probably the HIMS shrink...

2. I guess at this point it's best to just let this all just dissolve away in the next 6 months and start fresh with all the new information, with no medical omissions.

3. This will give me time to
a) disclose the HIV Status with proper documentation,
b) meet with a HIMS AME to discuss any substance abuse issues and follow their guidelines
c) no harm no foul as I let the previous submission disappear.
d) One SI to cover both situations

Share your thoughts on this.....I know it's gonna be lengthy and I know it's gonna be costly....

I'm hoping to come out of this honest and open and ready to fly...
 
Wait... so your AME submitted an application without disclosure of your HIV status? That could get complicated, even if you wait (accept the denial) and apply again.

I would strongly suggest discussing this with Dr. Bruce... and be ready for some scolding, followed by advice on the best way to proceed.
 
BayAreaFlyerNewPilot said:
but it was kicked back for further review due to a DUI 7 years ago.





c) no harm no foul as I let the previous submission disappear.
Click to expand...
These two statements don't go together. It sounds like the AME submitted the form. If so, then you have committed an act which the FAA would consider lying on your application. If so, you will need to be pro-active about your situation. What may happen is down the road after you have been issued your pilot certificate, you may receive a letter from the FAA revoking all of your certificates. Not just your medical, but your pilot certificate, as well. The FAA does check the databases and compare against your medical application eventually, even if they don't before the certificate is issued. When that happens, they send you a registered letter demanding you return all of your certificates. You then have to wait a period of time (usually a year), and you have to reapply for everything, including re-taking the written exam, and the check ride, if you want your certificates back.
 
You need to talk to Dr Bruce Chien, check out his website and contact him. The HIV deal may or may not be a problem as with the DUI if you can prove you are sober PER the standard that Dr Bruce tells you the FAA requires. Make the contact and get real info for an informed decision on how to proceed.
 
Agree with the others... this new bit of information just provided about the alcohol offense comes with its own set of land mines to navigate.

I also say you should deal only with Dr. Bruce on this. Like Azure said, expect some major scolding, but if you agree to his "are you ready to commit and see this all the way through?" requirements, then he is one of the best in the land.

As I see things, you have three major hurdles to deal with.
  1. The alcohol offense
  2. The requirements for the HIV special issuance
  3. "Lying" by omission on a Federal form.

And you need a true expert on how the FAA medical system works. And that likely is not an AME close to your home, but is Dr. Bruce. Maybe Dr. Lou of Pensacola, FL.

_____________________________

Below is another one of my "cut and paste" creations, but this time for alcohol issues. Hopefully this will provide insight as to what the journey will be to deal with how the FAA deals with it.

... that you have on record a DUI incident, that is big thing that the FAA is going to want to know all about. And it isn’t just that individual single point in time. They want to know SIGNIFICANTLY more about your overall physical and psychological makeup that got you there and allows you to get there as it pertains to alcohol.

The FAA acts as a warden to prevent individuals that have developed a tolerance for high alcohol limits from obtaining and exercising pilot privileges. So for individuals such as yourself, the ball will be placed squarely in your court to prove beyond shadows of doubt that you are willing to prove you are worthy of flying privileges by doing everything they will ask of you.

The letter you are going to get from the FAA regarding the alcohol offense will have the specific details of what the FAA wants. Search back through this forum, and you will see that the requirements will include
  • A $6000 to $10,000 budget to pay for they various things the FAA will require of you.
  • A neuro cognative psychological screen of extreme depth that only a very few HIMS psychologists can administer, paid for out of your pocket
  • Direct sponsorship with a Senior HIMS AME, to whom you report to frequently and to whom you must demonstrate you are doing what is required to earn the medical certificate. There are very, very few of these AME’s, so plan onfrequent travel to see the one who is working your case.
  • 90 days of intensive alcohol dependency treatment.
  • 100% sobriety and abstinence from all alcohol. Wine with girlfriend and beer with buddies is now verboten,
    für immer
  • Documented attendance with alcohol dependency meetings
  • Many, many random pee in the cup whiz quizzes
  • And much, much more.

All of this must be done in exacting detail for you to be granted a Special Issuance medical. Only after continued proven 100% sobriety for a long period of time will you be allowed back into the normal issuance group.

Reading this and then saying back to us, “but I am not an alcoholic, I do not have a drinking problem” is an incorrect response.

The correct response is saying, “fine, I have a problem. Let’s get with meeting the requirements and make this thing happen.”

Humble and humility wins the day over arrogance and unwillingness to accept and change.
 
OP, please email me; I've been through this. You're getting good advice here, but my personal experience may be helpful.
k4drd<at>earthlink.net.
 
my most difficult case actually failed his 1st neurocog testing. We then found a neuropsychologist that specializes solely in neurocognitive rehabilitation ( ps there are not many around) engaged such and were successful. Airman is now faculty/CFI at a major Univ with a 'feeder' in waiting when he attains requisite hours.
 
mtuomi said:
I'm curious - why is this relevant for a HIV positive airman?
Click to expand...
bflynn said:
Google tells me it is because there is a specific cognitive dysfunction associated with HIV called “HIV-associated neurocognitive disorder”. So there has to be a check for it.
Click to expand...

I don't believe it is relevant anymore, but early in the epidemic there were many cases of the virus crossing the blood-brain barrier and causing HAND (HIV Associated Neurocognitive Disorder).

Recent studies (post 2014) show no statistically significant difference in cognitive impairment between HIV positive individuals on HAART (Highly Active Anti-Retroviral Therapy) with undetectable viral load and the general population in given age groups.
 
Stan Cooper said:
Recent studies (post 2014) show no statistically significant difference in cognitive impairment between HIV positive individuals on HAART (Highly Active Anti-Retroviral Therapy) with undetectable viral load and the general population in given age groups.
Click to expand...

Really? Then in about 15 years the FAA occupational medicine should probably catch up on the medicine and those out there who have HIV will be spared the unnecessary testing. Or they realize that if it isn’t associated with HIV, then it means any of us could have CI and they just make everyone test for it.
 
Would seem to me in theory anyway you could fight through the first class three medical and then go on Basic Med assuming you are not planning on a career in aviation.

Then there would be no need for a cog test every 2 years.
 
DFH65 said:
Would seem to me in theory anyway you could fight through the first class three medical and then go on Basic Med assuming you are not planning on a career in aviation.

Then there would be no need for a cog test every 2 years.
Click to expand...
And, assuming you contracted HIV after your first 3rd class medical, there would be no legal requirement for a SI for the HIV as HIV is not one of the conditions requiring the one-time SI.

Unfortunately though, that does not help the OP.
 
If you're in the SF bay area, I'd call Dr Robert Keller in Monterey and use him as your AME. Great guy. Great Doc. Great AME. Hell, I'm flying back from Texas to see him for my 3rd class renewal in Sept.
 
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