WHO Disease Staging System for HIV Infection and Disease in Adults and Adolescents
WHO Disease Staging System for HIV Infection and Disease in Adults and Adolescents was first produced in 1990 by the World Health Organization [1] 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.[2]
Following infection with HIV, the rate of clinical disease progression varies enormously between individuals. Many factors such as host susceptibility and immune function, [3][2][4] health care and co-infections, [5][6][7] as well as factors relating to the viral strain [8][9] may affect the rate of clinical disease progression.
Revised World Health Organization (WHO) Clinical Staging of HIV/AIDS For Adults and Adolescents (2005)
(This is the interim African Region version for persons aged 15 years or more who have had a positive HIV antibody test or other laboratory evidence of HIV infection) (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)
Primary HIV infection
- Asymptomatic
- Acute retroviral syndrome
Clinical stage 1
- Asymptomatic
- Persistent generalized lymphadenopathy
Clinical stage 2
- Moderate and unexplained weight loss (<10% of presumed or measured body weight)
- Recurrent respiratory tract infections (such as sinusitis, bronchitis, otitis media, pharyngitis)
- Herpes zoster
- Recurrent oral ulcerations
- Papular pruritic eruptions
- Angular cheilitis
- Seborrhoeic dermatitis
- Fungal finger nail infections
Clinical stage 4
Conditions where a presumptive diagnosis can be made on the basis of clinical signs or simple investigations
- HIV wasting syndrome
- Pneumocystis pneumonia
- Recurrent severe or radiological bacterial pneumonia
- Chronic herpes simplex infection (orolabial, genital or anorectal of more than one month’s duration)
- Oesophageal candidiasis
- Extrapulmonary Tuberculosis
- Kaposi’s sarcoma
- Central nervous system toxoplasmosis
- HIV encephalopathy
Conditions where confirmatory diagnostic testing is necessary
- Extrapulmonary cryptococcosis including meningitis
- Disseminated non-tuberculous mycobacteria infection
- Progressive multifocal leukoencephalopathy
- Candida of trachea, bronchi or lungs
- Cryptosporidiosis
- Isosporiasis
- Visceral herpes simplex infection
- Cytomegalovirus (CMV) infection (retinitis or of an organ other than liver, spleen or lymph nodes)
- Any disseminated mycosis (e.g. histoplasmosis, coccidiomycosis, penicilliosis)
- Recurrent non-typhoidal salmonella septicaemia
- Lymphoma (cerebral or B cell non-Hodgkin)
- Invasive cervical carcinoma
- Visceral leishmaniasis
Original proposal in 1990
Clinical Stage I
- Asymptomatic
- Generalised lymphadenopathy
Performance scale: 1: asymptomatic, normal activity.
Clinical Stage II
- Weight loss, < 10% of body weight
- Minor mucocutaneous manifestations (seborrheic dermatitis, prurigo, fungal nail infections, recurrent oral ulcerations, angular cheilitis)
- Herpes zoster within the last five years
- Recurrent upper respiratory tract infections (i.e. bacterial sinusitis)
And/or performance scale 2: symptomatic, normal activity.
Clinical Stage III
- Weight loss, > 10% of body weight
- Unexplained chronic diarrhoea > 1 month
- Unexplained prolonged fever (intermittent or constant), > 1 month
- Oral [candidiasis] ([thrush])
- Oral hairy leucoplakia
- Pulmonary tuberculosis
- Severe bacterial infections (i.e. pneumonia, pyomyositis)
And/or performance scale 3: bedridden < 50% of the day during last month.
Clinical Stage IV
The declaration of AIDS
- HIV wasting syndrome *
- Pneumocystis carinii pneumonia
- Toxoplasmosis of the brain
- Cryptosporidiosis with diarrhoea > 1 month
- Cryptococcosis, extrapulmonary
- Cytomegalovirus disease of an organ other than liver, spleen or lymph node (ex: retinitis)
- Herpes simplex virus infection, mucocutaneous (>1 month) or visceral
- Progressive multifocal leucoencephalopathy
- Any disseminated endemic mycosis
- Candidiasis of esophagus, trachea, bronchi
- Atypical mycobacteriosis, disseminated or lungs
- Non-typhoid Salmonella septicemia
- Extrapulmonary tuberculosis
- Lymphoma
- Kaposi's sarcoma
- HIV encephalopathy **
And/or performance scale 4: bedridden > 50% of the day during last month.
(*) 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).
(**) 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.
References
- ↑ WHO (1990). "Interim proposal for a WHO Staging System for HIV infection and Disease" (PDF). Wkly Epidemiol Rec. 65 (29): 221–224. PMID 11809639.
- ↑ 2.0 2.1 Morgan D, Mahe C, Mayanja B, Whitworth JA. (2002). "Progression to symptomatic disease in people infected with HIV-1 in rural Uganda: prospective cohort study". BMJ. 324 (7331): 193–196. PMID 11809639.
- ↑ Clerici M, Balotta C, Meroni L, Ferrario E, Riva C, Trabattoni D, Ridolfo A, Villa M, Shearer GM, Moroni M, Galli M. (1996). "Type 1 cytokine production and low prevalence of viral isolation correlate with long-term nonprogression in HIV infection". AIDS Res Hum Retroviruses. 12 (11): 1053–1061. PMID 8827221.
- ↑ Tang J, Kaslow RA. (2003). "The impact of host genetics on HIV infection and disease progression in the era of highly active antiretroviral therapy". AIDS. 17 (Suppl 4): S51–S60. PMID 15080180.
- ↑ Gendelman HE, Phelps W, Feigenbaum L, Ostrove JM, Adachi A, Howley PM, Khoury G, Ginsberg HS, Martin MA. (1986). "Trans-activation of the human immunodeficiency virus long terminal repeat sequence by DNA viruses". Proc Natl Acad Sci U S A. 83 (24): 9759–9763. PMID 2432602.
- ↑ Bentwich Z, Kalinkovich A, Weisman Z. (1995). "Immune activation is a dominant factor in the pathogenesis of African AIDS". Immunol Today. 16 (4): 187–191. PMID 7734046.
- ↑ Morgan D, Mahe C, Mayanja B, Okongo JM, Lubega R, Whitworth JA. (2002). "HIV-1 infection in rural Africa: is there a difference in median time to AIDS and survival compared with that in industrialized countries?". AIDS. 16 (4): 597–603. PMID 11873003.
- ↑ Quinones-Mateu ME, Mas A, Lain de Lera T, Soriano V, Alcami J, Lederman MM, Domingo E. (1998). "LTR and tat variability of HIV-1 isolates from patients with divergent rates of disease progression". Virus Res. 57 (1): 11–20. PMID 9833881.
- ↑ 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. (2004). "The glutamine-rich region of the HIV-1 Tat protein is involved in T-cell apoptosis". J Biol Chem. 279 (46): 48197–48204. PMID 15331610.
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