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| '''WHO Disease Staging System for HIV Infection and Disease in Adults and Adolescents''' was first produced in 1990 by the [[World Health Organization]] <ref name=WHO>{{
| | #REDIRECT [[AIDS classification]] |
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| | author=[[WHO]] | title=Interim proposal for a WHO Staging System for HIV infection and Disease. | journal=Wkly Epidemiol Rec. | year=1990 | pages=221-224 | volume=65 | issue=29 | id={{PMID|11809639}} | url=http://whqlibdoc.who.int/wer/WHO_WER_1990/WER1990_65_221-228%20(N°29).pdf
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| }}</ref> and updated in September 2005. It is an approach for use in resource limited settings and is widely used in Africa and Asia and has been a useful research tool in studies of progression to symptomatic [[HIV]] [[disease]].<ref name=MorganBMJ>{{
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| | author=Morgan D, Mahe C, Mayanja B, Whitworth JA. | title=Progression to symptomatic disease in people infected with HIV-1 in rural Uganda: prospective cohort study | journal=BMJ | year=2002 | pages=193-196 | volume=324 | issue=7331 | id={{PMID|11809639}}
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| }}</ref>
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| Following infection with HIV, the rate of clinical disease progression varies enormously between individuals. Many factors such as host susceptibility and immune function, <ref name=Clerici>{{
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| | author=Clerici M, Balotta C, Meroni L, Ferrario E, Riva C, Trabattoni D, Ridolfo A, Villa M, Shearer GM, Moroni M, Galli M. | title=Type 1 cytokine production and low prevalence of viral isolation correlate with long-term nonprogression in HIV infection | journal=AIDS Res Hum Retroviruses. | year=1996 | pages=1053-1061 | volume=12 | issue=11 | id={{PMID|8827221}}
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| }}</ref><ref name=MorganBMJ>{{
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| cite journal
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| | author=Morgan D, Mahe C, Mayanja B, Whitworth JA. | title=Progression to symptomatic disease in people infected with HIV-1 in rural Uganda: prospective cohort study | journal=BMJ | year=2002 | pages=193-196 | volume=324 | issue=7331 | id={{PMID|11809639}}
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| }}</ref><ref name=Tang>{{
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| cite journal
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| | author=Tang J, Kaslow RA. | title=The impact of host genetics on HIV infection and disease progression in the era of highly active antiretroviral therapy | journal=AIDS | year=2003 | pages=S51-S60 | volume=17 | issue=Suppl 4 | id={{PMID|15080180}}
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| }}</ref> health care and co-infections, <ref name=Gendelman>{{
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| | author=Gendelman HE, Phelps W, Feigenbaum L, Ostrove JM, Adachi A, Howley PM, Khoury G, Ginsberg HS, Martin MA. | title=Trans-activation of the human immunodeficiency virus long terminal repeat sequence by DNA viruses | journal=Proc Natl Acad Sci U S A. | year=1986 | pages=9759-9763 | volume=83 | issue=24 | id={{PMID|2432602}}
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| }}</ref><ref name=Bentwich>{{
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| | author=Bentwich Z, Kalinkovich A, Weisman Z. | title=Immune activation is a dominant factor in the pathogenesis of African AIDS | journal=Immunol Today. | year=1995 | pages=187-191 | volume=16 | issue=4 | id={{PMID|7734046}}
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| }}</ref><ref name=MorganAIDS>{{
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| | author=Morgan D, Mahe C, Mayanja B, Okongo JM, Lubega R, Whitworth JA. | title=HIV-1 infection in rural Africa: is there a difference in median time to AIDS and survival compared with that in industrialized countries? | journal=AIDS | year=2002 | pages=597-603 | volume=16 | issue=4 | id={{PMID|11873003}}
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| }}</ref> as well as factors relating to the viral strain <ref name=Quinones>{{
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| | author=Quinones-Mateu ME, Mas A, Lain de Lera T, Soriano V, Alcami J, Lederman MM, Domingo E. | title=LTR and tat variability of HIV-1 isolates from patients with divergent rates of disease progression | journal=Virus Res. | year=1998 | pages=11-20 | volume=57 | issue=1 | id={{PMID|9833881}}
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| }}</ref><ref name=Campbell>{{
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| | author=Campbell GR, Pasquier E, Watkins J, Bourgarel-Rey V, Peyrot V, Esquieu D, Barbier P, de Mareuil J, Braguer D, Kaleebu P, Yirrell DL, Loret EP. | title=The glutamine-rich region of the HIV-1 Tat protein is involved in T-cell apoptosis. | journal=J Biol Chem. | year=2004 | pages=48197-48204 | volume=279 | issue=46 | id={{PMID|15331610}}
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| }}</ref> may affect the rate of clinical disease progression.
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| ==Revised World Health Organization (WHO) Clinical Staging of HIV/AIDS For Adults and Adolescents (2005)==
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| (This is the interim [[Africa]]n Region version for persons aged 15 years or more who have had a positive HIV antibody test or other laboratory evidence of HIV infection)
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| (It must be noted that the [[UN]] defines adolescents as persons aged 10−19 years but for surveillance purposes, the category of adults and adolescents comprises people aged 15 years and over)
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| ===Primary HIV infection===
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| *Asymptomatic
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| *Acute retroviral syndrome
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| ===Clinical stage 1===
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| *Asymptomatic
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| *Persistent generalized [[lymphadenopathy]]
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| ===Clinical stage 2===
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| *Moderate and unexplained weight loss (<10% of presumed or measured body weight)
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| *Recurrent respiratory tract infections (such as [[sinus]]itis, [[bronchitis]], [[otitis]] media, [[pharyngitis]])
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| *[[Herpes zoster]]
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| *Recurrent oral ulcerations
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| *Papular pruritic eruptions
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| *Angular cheilitis
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| *Seborrhoeic dermatitis
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| *Fungal finger nail infections
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| ===Clinical stage 4===
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| '''''Conditions where a presumptive diagnosis can be made on the basis of clinical signs or simple investigations'''''
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| *HIV wasting syndrome
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| *Pneumocystis pneumonia
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| *Recurrent severe or radiological bacterial pneumonia
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| *Chronic herpes simplex infection (orolabial, genital or anorectal of more than one month’s duration)
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| *Oesophageal candidiasis
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| *Extrapulmonary Tuberculosis
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| *Kaposi’s sarcoma
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| *Central nervous system toxoplasmosis
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| *HIV encephalopathy
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| '''''Conditions where confirmatory diagnostic testing is necessary'''''
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| *Extrapulmonary cryptococcosis including meningitis
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| *Disseminated non-tuberculous mycobacteria infection
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| *Progressive multifocal leukoencephalopathy
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| *Candida of trachea, bronchi or lungs
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| *Cryptosporidiosis
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| *Isosporiasis
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| *Visceral herpes simplex infection
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| *Cytomegalovirus ([[CMV]]) infection (retinitis or of an organ other than liver, spleen or lymph nodes)
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| *Any disseminated mycosis (e.g. histoplasmosis, coccidiomycosis, penicilliosis)
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| *Recurrent non-typhoidal salmonella septicaemia
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| *Lymphoma (cerebral or B cell non-Hodgkin)
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| *Invasive cervical carcinoma
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| *Visceral leishmaniasis
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| ==Original proposal in 1990==
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| ===Clinical Stage I===
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| * Asymptomatic
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| * Generalised lymphadenopathy
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| Performance scale: 1: asymptomatic, normal activity.
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| ===Clinical Stage II===
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| * Weight loss, < 10% of body weight
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| * Minor mucocutaneous manifestations (seborrheic dermatitis, [[prurigo]], fungal nail infections, recurrent oral ulcerations, angular cheilitis)
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| * [[Herpes zoster]] within the last five years
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| * Recurrent upper respiratory tract infections (i.e. bacterial sinusitis)
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| And/or performance scale 2: symptomatic, normal activity.
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| ===Clinical Stage III===
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| * Weight loss, > 10% of body weight
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| * Unexplained chronic [[diarrhoea]] > 1 month
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| * Unexplained prolonged fever (intermittent or constant), > 1 month
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| * Oral [candidiasis] ([thrush])
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| * Oral hairy [[leucoplakia]]
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| * [[Tuberculosis|Pulmonary tuberculosis]]
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| * Severe [[bacteria|bacterial]] [[infections]] (i.e. [[pneumonia]], [[pyomyositis]])
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| And/or performance scale 3: bedridden < 50% of the day during last month.
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| ===Clinical Stage IV===
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| ''The declaration of AIDS''
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| * HIV wasting syndrome *
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| * [[Pneumocystis jiroveci pneumonia|Pneumocystis carinii pneumonia]]
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| * [[Toxoplasmosis]] of the brain
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| * [[Cryptosporidiosis]] with diarrhoea > 1 month
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| * [[Cryptococcosis]], extrapulmonary
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| * [[Cytomegalovirus]] disease of an organ other than [[liver]], [[spleen]] or [[lymph node]] (ex: retinitis)
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| * [[Herpes simplex virus]] infection, mucocutaneous (>1 month) or visceral
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| * Progressive multifocal [[leucoencephalopathy]]
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| * Any disseminated endemic mycosis
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| * [[Candidiasis]] of esophagus, trachea, bronchi
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| * Atypical mycobacteriosis, disseminated or lungs
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| * Non-typhoid [[Salmonella]] [[septicemia]]
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| * [[Extrapulmonary tuberculosis]]
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| * [[Lymphoma]]
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| * [[Kaposi's sarcoma]]
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| * HIV encephalopathy **
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| And/or performance scale 4: bedridden > 50% of the day during last month.
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| (*) HIV wasting syndrome: weight loss of > 10% of body weight, plus either unexplained chronic diarrhoea (> 1 month) or chronic weakness and unexplained prolonged fever (> 1 month).
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| (**) HIV encephalopathy: clinical findings of disabling cognitive and/or motor dysfunction interfering with activities of daily living, progressing over weeks to months, in the absence of a concurrent illness or condition other than HIV infection which could explain the findings.
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| ==References==
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| <references/>
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| {{AIDS}}
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| [[Category:HIV/AIDS]]
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| {{WikiDoc Help Menu}}
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| {{WikiDoc Sources}}
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