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__NOTOC__
{{AIDS}}
{{AIDS}}
{{CMG}}; {{AE}} {{Ammu}}


'''For AIDS Patient Information click [[AIDS Patient Information|here]]'''
==Overview==
 
Many definitions have been developed for [[epidemiology|epidemiological]] surveillance of HIV/AIDS such as the ''Bangui definition'' and the ''1994 Expanded World Health Organization AIDS Case Definition''. However, these systems are neither sensitive nor specific for clinical staging. In developing countries, the [[World Health Organization]] staging system for HIV infection and disease that uses clinical and laboratory data is widely employed. The [[Centers for Disease Control and Prevention|Centers for Disease Control]] (CDC) Classification System for HIV/AIDS is another primary system used that is primarily based on [[T helper cells|CD4 T-lymphocyte]] counts.
{{CMG}}


==Overview==
[[Image:TEM HIV.jpg|thumb|200px|Thin-section transmission electron micrograph (TEM) depicting the ultrastructural details of two ”human immunodeficiency virus” (HIV) virions]]
[[Image:Kaposi's_sarcoma.jpg|thumb|Kaposi's sarcoma lesion commonly found in patients with stage IV AIDS]]
Since June 5, 1981, many definitions have been developed for [[epidemiology|epidemiological]] surveillance such as the Bangui definition and the 1994 expanded World Health Organization AIDS case definition. However, clinical staging of patients was not an intended use for these systems as they are neither sensitive, nor specific. In developing countries, the [[World Health Organization]] staging system for HIV infection and disease, using clinical and laboratory data, is used and in developed countries, the [[Centers for Disease Control and Prevention|Centers for Disease Control]] (CDC) Classification System is used.
==Classification==
==Classification==
===WHO disease staging system for HIV infection and disease===
===WHO Staging System for HIV Infection and Disease in Adults and Adolescents<ref name=who>WHO case definitions of HIV for surveillance and revised clinical staging and immunological classification of HIV-related disease in adults and children. 2006.</ref>===
{{main|WHO Disease Staging System for HIV Infection and Disease}}


In 1990, the [[World Health Organization]] (WHO) grouped these infections and conditions together by introducing a staging system for patients infected with HIV-1.<ref name=WHO>{{
{| style="border: 0px; font-size: 90%; margin: 3px; width:950px " align=center
! style="background: #4479BA; width: 120px;" | {{fontcolor|#FFF|Clinical stage}}
! style="background: #4479BA; width: 550px;" | {{fontcolor|#FFF|Features}}
|-
| style="padding: 5px 5px; background: #DCDCDC;" |Clinical stage 1
| style="padding: 5px 5px; background: #F5F5F5;" |
*Asymptomatic
*Generalized [[lymphadenopathy]]
|-
| style="padding: 5px 5px; background: #DCDCDC;" |Clinical stage 2
| style="padding: 5px 5px; background: #F5F5F5;" |
*[[Weight loss]] of less than 10% body weight
*Minor [[mucocutaneous]] manifestations
*[[Herpes]] Zooster within the last five years
*Recurrent respiratory tract infections (such as [[sinus]]itis, [[bronchitis]], [[otitis]] media, [[pharyngitis]])
*Recurrent oral [[ulcerations]]
*Papular pruritic eruptions
*Angular cheilitis
*Seborrhoeic [[dermatitis]]
*Fungal [[finger nail]] [[infections]]
|-
| style="padding: 5px 5px; background: #DCDCDC;" |Clinical stage 3
| style="padding: 5px 5px; background: #F5F5F5;" |


cite journal
'''''Conditions where a presumptive diagnosis can be made on the basis of clinical signs or simple investigations'''''
| author=World Health Organization
| title=Interim proposal for a WHO staging system for HIV infection and disease
| journal=WHO Wkly Epidem. Rec. | year=1990 | pages=221&ndash;228 | volume=65 | issue=29
| pmid=1974812


}}</ref> An update took place in September 2005. Most of these conditions are [[opportunistic infection]]s that are easily treatable in healthy people.
*Unexplained chronic [[diarrhoea]] for longer than one month
* Stage I: HIV infection is [[asymptomatic]] and not categorized as AIDS
*Unexplained persistent [[fever]] (intermittent or constant for longer than one month)
* Stage II: includes minor [[Mucous membrane|mucocutaneous]] manifestations and recurrent [[upper respiratory tract]] infections
*Severe [[weight loss]] (>10% of presumed or measured body weight)
* Stage III: includes unexplained [[Chronic (medical)|chronic]] [[diarrhea]]<!--STOP CHANGING THIS: this article is written in American English throughout. --> for longer than a month, severe bacterial infections and [[pulmonary]] tuberculosis
*Oral [[candidiasis]]
* Stage IV: includes [[toxoplasmosis]] of the [[brain]], [[candidiasis]] of the [[esophagus]], [[Vertebrate trachea|trachea]], [[bronchi]] or [[lung]]s and [[Kaposi's sarcoma]]; these diseases are indicators of AIDS.
*Oral hairy [[leukoplakia]]
*[[Pulmonary tuberculosis]] (TB) diagnosed in last two years
*Severe presumed bacterial [[infections]] (e.g. [[pneumonia]], [[empyema]], [[meningitis]], [[bacteraemia]], [[pyomyositis]], [[bone]] or [[joint]] [[infection]])
*Acute necrotizing ulcerative [[stomatitis]], [[gingivitis]] or [[periodontitis]]


===CDC classification system for HIV infection===
'''''Conditions where confirmatory diagnostic testing is necessary'''''
*Unexplained [[anaemia]] (< 80 g/l), and or [[neutropenia]](<500/µl) and or [[thrombocytopenia]] (<50 000/ µl) for more than one month
|-
| style="padding: 5px 5px; background: #DCDCDC;" |Clinical stage 4
| style="padding: 5px 5px; background: #F5F5F5;" |
'''''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 sarcoma]]
*Central nervous system [[toxoplasmosis]]
*HIV [[encephalopathy]]


{{main|CDC Classification System for HIV Infection}}
'''''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]]
|}


In the beginning, the [[Centers for Disease Control and Prevention]] (CDC) did not have an official name for the disease, often referring to it by way of the diseases that were associated with it, for example, [[lymphadenopathy]], the disease after which the discoverers of HIV originally named the virus.<ref name=MMWR1982a>{{
===WHO Staging System for HIV Infection and Disease in Children (Revised 2006) <ref name=who>WHO case definitions of HIV for surveillance and revised clinical staging and immunological classification of HIV-related disease in adults and children. 2006.</ref>===
{| style="border: 0px; font-size: 90%; margin: 3px; width:950px;" align=center
! style="background: #4479BA; width: 120px;" | {{fontcolor|#FFF|Clinical stage}}
! style="background: #4479BA; width: 550px;" | {{fontcolor|#FFF|Features}}
|-
| style="padding: 5px 5px; background: #DCDCDC;" |Clinical stage 1
| style="padding: 5px 5px; background: #F5F5F5;" |
*Asymptomatic
*Generalized [[lymphadenopathy]]
|-
| style="padding: 5px 5px; background: #DCDCDC;" |Clinical stage 2
| style="padding: 5px 5px; background: #F5F5F5;" |
*[[Hepatosplenomegaly]]
*Papular pruritic eruptions
*[[Seborrhoeic dermatitis]]
*Extensive human papilloma virus infection
*Extensive [[molluscum contagiosum]]
*Fungal nail [[infections]]
*Recurrent [[oral ulcerations]]
*Linear gingival erythema (LGE)
*Angular [[cheilitis]]
*[[Parotid]] enlargement
*[[Herpes zoster]]
*Recurrent or chronic RTIs (otitis media, otorrhoea, sinusitis)
*Chronic [[diarrhoea]] lasting for more than 30 days in the absence of known etiology
*Severe persistent or recurrent [[candidiasis]] outside the neonatal period
*[[Weight loss]] or [[failure to thrive]] in the absence of known etiology
*Persistent [[fever]] lasting for more than 30 days in the absence of known etiology.
*Recurrent severe bacterial [[infections]] other than [[septicemia]] or [[meningitis]] like [[osteomyelitis]], bacterial [[pneumonia]] or [[abscesses]]
|-
| style="padding: 5px 5px; background: #DCDCDC;" |Clinical stage 3
| style="padding: 5px 5px; background: #F5F5F5;" |


cite journal
'''''Conditions where a presumptive diagnosis can be made on the basis of clinical signs or simple investigations'''''
| author=Centers for Disease Control (CDC)
*Moderate unexplained [[malnutrition]] not adequately responding to standard therapy
| title=Persistent, generalized lymphadenopathy among homosexual males.
*Unexplained persistent [[diarrhoea]] (14 days or more )
| journal=MMWR Morb Mortal Wkly Rep. | year=1982 | pages=249&ndash;251 | volume=31| issue=19
*Unexplained persistent [[fever]] (intermittent or constant, for longer than one month)
| pmid=6808340
*Oral [[candidiasis]] (outside neonatal period )
*Oral hairy [[leukoplakia]]
*Acute necrotizing ulcerative [[gingivitis]]/[[periodontitis]]
*[[Pulmonary TB]]
*Severe recurrent presumed bacterial pneumonia
'''''Conditions where confirmatory diagnostic testing is necessary'''''


}}</ref><ref name=Barre>{{cite journal | author=Barré-Sinoussi F, Chermann JC, Rey F, et al | title=Isolation of a T-lymphotropic retrovirus from a patient at risk for acquired immune deficiency syndrome (AIDS) | journal=Science | year=1983 | pages=868–871 | volume=220 | issue=4599 | pmid=6189183 | doi=10.1126/science.6189183 | format=
*Chronic HIV-associated lung disease including [[brochiectasis]]
}}</ref> They also used ''Kaposi's Sarcoma and Opportunistic Infections'', the name by which a task force had been set up in 1981.<ref name=MMWR1982b>{{
*Lymphoid interstitial [[pneumonitis]] (LIP)
*Unexplained [[anaemia]] (<80g/l), and or [[neutropenia]] (<1000/µl) and or [[thrombocytopenia]] (<50 000/µl) for more than one month
|-
| style="padding: 5px 5px; background: #DCDCDC;" |Clinical stage 4
| style="padding: 5px 5px; background: #F5F5F5;" |
'''''Conditions where a presumptive diagnosis can be made on the basis of clinical signs or simple investigations'''''
*Unexplained severe wasting or severe [[malnutrition]] not adequately responding to standard therapy
*[[Pneumocystis pneumonia]]
*Recurrent severe presumed bacterial [[infections]] (e.g. [[empyema]], [[pyomyositis]], [[bone]] or joint infection, [[meningitis]], but excluding [[pneumonia]])
*Chronic [[herpes simplex]] infection; (orolabial or cutaneous of more than one month’s duration)
*Extrapulmonary [[Tuberculosis]]
*Kaposi’s sarcoma
*Oesophageal [[candidiasis]]
*Central nervous system [[toxoplasmosis]] (outside the neonatal period)
*HIV [[encephalopathy]]
'''''Conditions where confirmatory diagnostic testing is necessary'''''
*[[CMV]] infection (CMV retinitis or infection of organs other than liver, spleen or lymph nodes; onset at age one month or more)
*Extrapulmonary cryptococcosis including meningitis
*Any disseminated endemic mycosis (e.g. extrapulmonary histoplasmosis, coccidiomycosis, penicilliosis)
*[[Cryptosporidiosis]]
*[[Isosporiasis]]
*Disseminated non-tuberculous mycobacteria infection
*[[Candida]] of trachea, bronchi or lungs
*Visceral herpes simplex infection
*Acquired [[HIV]] associated rectal fistula
*Cerebral or B cell [[non-Hodgkin lymphoma]]
*[[Progressive multifocal leukoencephalopathy]] (PML)
*HIV-associated [[cardiomyopathy]] or HIV-associated [[nephropathy]]
|}


cite journal
==CDC Classification System==
| author=Centers for Disease Control (CDC)
| title=Opportunistic infections and Kaposi's sarcoma among Haitians in the United States
| journal=MMWR Morb Mortal Wkly Rep. | year=1982 | pages=353&ndash;354; 360&ndash;361 | volume=31 | issue=26
| pmid=6811853


}}</ref> In the general press, the term ''GRID'', which stood for [[Gay-related immune deficiency]], had been coined.<ref name=Altman>{{
The table below shows the HIV infection stage, based on age-specific CD4+ T-lymphocyte count or CD4+ T-lymphocyte percentage of total lymphocytes. <ref> {{cite web| url=http://www.cdc.gov/hiv/statistics/recommendations/terms.html| title=CDC HIV/AIDS Surveillance Publications}}</ref>


cite news
{{#widget:BlueTable}}
| author=Altman LK
{|class="BlueTable" style="width: 500px"
| title=New homosexual disorder worries officials
!rowspan=3|Stage*
| work=The New York Times | date=1982-05-11
!colspan=6|Age on date of CD4 T-lymphocyte test
|-
! colspan=2|<1 year
! colspan=2|1—5 years
! colspan=2|6 years through adult
|-
! Cells/µL||%||Cells/µL||%||Cells/µL||%
|-
| 1||≥1,500||≥34||≥1,000||≥30||≥500||≥26
|-
| 2||750—1,499||26—33||500—999||22—29||200—499||14—25
|-
| 3||<750||<26||<500||<22||<200||<14
|-
|colspan=7|<small> *The stage is based primarily on the CD4+ T-lymphocyte count; the CD4+ T-lymphocyte count takes precedence over the CD4 T-lymphocyte percentage, and the percentage is considered only if the count is missing.</small>
|}


}}</ref> However, after determining that AIDS was not isolated to the homosexual community,<ref name=MMWR1982b/> the term GRID became misleading and ''AIDS'' was introduced at a meeting in July 1982.<ref name=Kher>{{
==References==
 
{{reflist|2}}
cite news
| author=Kher U
| title=A Name for the Plague
| work=Time | date=1982-07-27 | url=http://www.time.com/time/80days/820727.html |accessdate=2008-03-10
 
}}</ref> By September 1982 the CDC started using the name AIDS, and properly defined the illness.<ref name=MMWR1982c>{{
 
cite journal
| author=Centers for Disease Control (CDC)
| title=Update on acquired immune deficiency syndrome (AIDS)—United States.
| journal=MMWR Morb Mortal Wkly Rep. | year=1982 | pages=507&ndash;508; 513&ndash;514 | volume=31 | issue=37
| pmid=6815471
 
}}</ref> In 1993, the CDC expanded their definition of AIDS to include all HIV positive people with a CD4<SUP>+</SUP> T cell count below 200 per µL of blood or 14% of all [[lymphocyte]]s.<ref name=MMWR>{{
 
cite web | publisher=[[Centers for Disease Control and Prevention|CDC]] | publisher=CDC | year=1992
| url=http://www.cdc.gov/mmwr/preview/mmwrhtml/00018871.htm
| title=1993 Revised Classification System for HIV Infection and Expanded Surveillance Case Definition for AIDS Among Adolescents and Adults
| accessdate = 2006-02-09
 
}}</ref> The majority of new AIDS cases in developed countries use either this definition or the pre-1993 CDC definition. The AIDS diagnosis still stands even if, after treatment, the CD4<SUP>+</SUP> T cell count rises to above 200 per µL of blood or other AIDS-defining illnesses are cured.
 
===HIV test===
{{main|HIV test}}
 
Many people are unaware that they are infected with HIV.<ref name=Kumaranayake>
 
{{cite journal
| author=Kumaranayake L, Watts C | title=
Resource allocation and priority setting of HIV/AIDS interventions: addressing the generalized epidemic in sub-Saharan Africa | journal=J. Int. Dev. | year=2001 | pages=451&ndash;466 | volume=13 | issue=4 | id={{DOI|10.1002/jid.798}}
 
}}</ref> Less than 1% of the sexually active urban population in Africa has been tested, and this proportion is even lower in rural populations. Furthermore, only 0.5% of pregnant women attending urban health facilities are counseled, tested or receive their test results. Again, this proportion is even lower in rural health facilities.<ref name=Kumaranayake>
 
{{cite journal
| author=Kumaranayake L, Watts C | title=
Resource allocation and priority setting of HIV/AIDS interventions: addressing the generalized epidemic in sub-Saharan Africa | journal=J. Int. Dev. | year=2001 | pages=451&ndash;466 | volume=13 | issue=4 | id={{DOI|10.1002/jid.798}}


}}</ref> Therefore, donor blood and blood products used in medicine and medical research are screened for HIV.
{{WH}}
{{WS}}


HIV tests are usually performed on venous blood. Many laboratories  use ''fourth generation'' screening tests which detect anti-HIV  antibody (IgG and IgM) and the HIV p24 antigen. The detection of HIV antibody or antigen in a patient previously known to be negative  is evidence of HIV infection. Individuals whose first specimen indicates evidence of HIV infection will have a repeat test on a second blood sample to confirm the results. The window period (the time between initial infection and the development of detectable antibodies against the infection) can vary since it can take 3&ndash;6&nbsp;months to [[seroconversion|seroconvert]] and to test positive. Detection of the virus using polymerase chain reaction ([[PCR]]) during the window period is possible, and evidence suggests that an infection may often be detected earlier than when using a fourth generation EIA screening test.  Positive results obtained by PCR are confirmed by antibody tests.<ref name="pmid16706742">{{cite journal
[[Category:HIV/AIDS]]
|author=Weber B
[[Category:Disease]]
|title=Screening of HIV infection: role of molecular and immunological assays
[[Category:Immune system disorders]]
|journal=Expert Rev. Mol. Diagn.
[[Category:Viral diseases]]
|volume=6
[[Category:Pandemics]]
|issue=3
[[Category:Sexually transmitted infections]]
|pages=399-411
[[Category:Syndromes]]
|year=2006
[[Category:Virology]]
|pmid=16706742
[[Category:AIDS origin hypotheses]]
|doi=10.1586/14737159.6.3.399
[[Category:Medical disasters]]
|url=http://dx.doi.org/10.1586/14737159.6.3.399
[[Category:Acronyms]]
}}</ref>
[[Category:Immunodeficiency]]
Routinely used HIV tests for infection in [[neonates]], born to HIV-positive mothers, have no value because of the presence of maternal antibody to HIV in the child's blood. HIV infection can only be diagnosed by  PCR, testing for HIV pro-viral DNA in the children's [[lymphocyte]]s.<ref name="pmid11791341">{{cite journal
[[Category:Microbiology]]
|author=Tóth FD, Bácsi A, Beck Z, Szabó J
[[Category:Emergency mdicine]]
|title=Vertical transmission of human immunodeficiency virus
[[Category:Up-To-Date]]
|journal=Acta Microbiol Immunol Hung
[[Category:Infectious disease]]
|volume=48
|issue=3-4
|pages=413-27
|year=2001
|pmid=11791341
}}</ref>
==References==
{{reflist|3}}

Latest revision as of 22:11, 29 July 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ammu Susheela, M.D. [2]

Overview

Many definitions have been developed for epidemiological surveillance of HIV/AIDS such as the Bangui definition and the 1994 Expanded World Health Organization AIDS Case Definition. However, these systems are neither sensitive nor specific for clinical staging. In developing countries, the World Health Organization staging system for HIV infection and disease that uses clinical and laboratory data is widely employed. The Centers for Disease Control (CDC) Classification System for HIV/AIDS is another primary system used that is primarily based on CD4 T-lymphocyte counts.

Classification

WHO Staging System for HIV Infection and Disease in Adults and Adolescents[1]

Clinical stage Features
Clinical stage 1
Clinical stage 2
Clinical stage 3

Conditions where a presumptive diagnosis can be made on the basis of clinical signs or simple investigations

Conditions where confirmatory diagnostic testing is necessary

Clinical stage 4

Conditions where a presumptive diagnosis can be made on the basis of clinical signs or simple investigations

Conditions where confirmatory diagnostic testing is necessary

WHO Staging System for HIV Infection and Disease in Children (Revised 2006) [1]

Clinical stage Features
Clinical stage 1
Clinical stage 2
Clinical stage 3

Conditions where a presumptive diagnosis can be made on the basis of clinical signs or simple investigations

Conditions where confirmatory diagnostic testing is necessary

Clinical stage 4

Conditions where a presumptive diagnosis can be made on the basis of clinical signs or simple investigations

Conditions where confirmatory diagnostic testing is necessary

CDC Classification System

The table below shows the HIV infection stage, based on age-specific CD4+ T-lymphocyte count or CD4+ T-lymphocyte percentage of total lymphocytes. [2]

Stage* Age on date of CD4 T-lymphocyte test
<1 year 1—5 years 6 years through adult
Cells/µL % Cells/µL % Cells/µL %
1 ≥1,500 ≥34 ≥1,000 ≥30 ≥500 ≥26
2 750—1,499 26—33 500—999 22—29 200—499 14—25
3 <750 <26 <500 <22 <200 <14
*The stage is based primarily on the CD4+ T-lymphocyte count; the CD4+ T-lymphocyte count takes precedence over the CD4 T-lymphocyte percentage, and the percentage is considered only if the count is missing.

References

  1. 1.0 1.1 WHO case definitions of HIV for surveillance and revised clinical staging and immunological classification of HIV-related disease in adults and children. 2006.
  2. "CDC HIV/AIDS Surveillance Publications".

Template:WH Template:WS