HIV AIDS classification: Difference between revisions

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Latest revision as of 22:11, 29 July 2020

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	Asymptomatic Generalized lymphadenopathy
Clinical stage 2	Weight loss of less than 10% body weight Minor mucocutaneous manifestations Herpes Zooster within the last five years Recurrent respiratory tract infections (such as sinusitis, bronchitis, otitis media, pharyngitis) Recurrent oral ulcerations Papular pruritic eruptions Angular cheilitis Seborrhoeic dermatitis Fungal finger nail infections
Clinical stage 3	Conditions where a presumptive diagnosis can be made on the basis of clinical signs or simple investigations Unexplained chronic diarrhoea for longer than one month Unexplained persistent fever (intermittent or constant for longer than one month) Severe weight loss (>10% of presumed or measured body weight) Oral candidiasis 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 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
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 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

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

Clinical stage	Features
Clinical stage 1	Asymptomatic Generalized lymphadenopathy
Clinical stage 2	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
Clinical stage 3	Conditions where a presumptive diagnosis can be made on the basis of clinical signs or simple investigations Moderate unexplained malnutrition not adequately responding to standard therapy Unexplained persistent diarrhoea (14 days or more ) Unexplained persistent fever (intermittent or constant, for longer than one month) 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 Chronic HIV-associated lung disease including brochiectasis Lymphoid interstitial pneumonitis (LIP) Unexplained anaemia (<80g/l), and or neutropenia (<1000/µl) and or thrombocytopenia (<50 000/µl) for more than one month
Clinical stage 4	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

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

↑ ^1.0 ^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.
↑ "CDC HIV/AIDS Surveillance Publications".

Template:WH Template:WS

[who-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".

[1]

[2]

@@ Line 1: / Line 1: @@
 __NOTOC__
 {{AIDS}}
-{{CMG}} ; {{AE}} {{Ammu}}
+{{CMG}}; {{AE}} {{Ammu}}
 ==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, clinical staging of patients was not an intended use for these systems as they are neither sensitive, nor specific for that purpose. 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.
+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.
 ==Classification==
-===WHO Staging System for HIV Infection and Disease in Adults and Adolescents<small><ref name=CDC>{{cite web | title = CDC Global AIDS module| url = http://www.cdc.gov/globalaids/Resources/pmtct-care/docs/PM/Module_1PM.pdf }}</ref></small>===
+===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>===
 {| style="border: 0px; font-size: 90%; margin: 3px; width:950px " align=center
@@ Line 26: / Line 27: @@
 *Papular pruritic eruptions
 *Angular cheilitis
-*[[Seborrhoeic]] [[dermatitis]]
+*Seborrhoeic [[dermatitis]]
 *Fungal [[finger nail]] [[infections]]
 |-
@@ Line 75: / Line 76: @@
 |}
-===WHO Staging System for HIV Infection and Disease in Children===
+===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}}
@@ Line 89: / Line 89: @@
 | style="padding: 5px 5px; background: #F5F5F5;" |
 *[[Hepatosplenomegaly]]
-*[[Papular pruritic eruptions]]
+*Papular pruritic eruptions
 *[[Seborrhoeic dermatitis]]
-*Extensive [[human papilloma virus infection]]
+*Extensive human papilloma virus infection
 *Extensive [[molluscum contagiosum]]
-*Fungal [[nail]] [[infections]]
+*Fungal nail [[infections]]
 *Recurrent [[oral ulcerations]]
-*[[Linear gingival erythema]] (LGE)
+*Linear gingival erythema (LGE)
 *Angular [[cheilitis]]
 *[[Parotid]] enlargement
@@ Line 129: / Line 129: @@
 *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]])
+*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]]
+*Kaposi’s sarcoma
 *Oesophageal [[candidiasis]]
 *Central nervous system [[toxoplasmosis]] (outside the neonatal period)
@@ Line 142: / Line 142: @@
 *[[Cryptosporidiosis]]
 *[[Isosporiasis]]
-*Disseminated non-tuberculous [[mycobacteria infection]]
+*Disseminated non-tuberculous mycobacteria infection
 *[[Candida]] of trachea, bronchi or lungs
-*Visceral [[herpes simplex infection]]
+*Visceral herpes simplex infection
 *Acquired [[HIV]] associated rectal fistula
 *Cerebral or B cell [[non-Hodgkin lymphoma]]
@@ Line 151: / Line 151: @@
 |}
-===CDC Classification System for HIV Infection===
+==CDC Classification System==
-*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>{{
- cite journal
- | author=Centers for Disease Control (CDC)
- | title=Persistent, generalized lymphadenopathy among homosexual males.
- | journal=MMWR Morb Mortal Wkly Rep. | year=1982 | pages=249&ndash;251 | volume=31| issue=19
- | pmid=6808340
-}}</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=
-}}</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>{{
- cite journal
- | 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>{{
- cite news
- | author=Altman LK
- | title=New homosexual disorder worries officials
- | work=The New York Times | date=1982-05-11
-}}</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>{{
- 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.
-==CDC Classification==
 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>
@@ Line 228: / Line 174: @@
 |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>
 |}
-==CDC Classification System for HIV Infection in Children==
-In the new system, HIV-infected children are classified into mutually exclusive categories according to three parameters:
-:a) infection status
-:b) clinical status
-:c) immunologic status
-This classification system reflects the stage of the child's disease, establishes mutually exclusive classification categories, and balances simplicity and medical accuracy in the classification process. This document also describes revised pediatric definitions for two acquired immunodeficiency syndrome-defining conditions.
-When an infant is born to an HIV-infected mother, diagnosis of an HIV infection is complicated by the presence of maternal anti-HIV IgG antibody, which crosses the placenta to the fetus. Indeed, virtually all children born to HIV-infected mothers are HIV-antibody positive at birth, although only 15%-30% are actually infected.
-{| 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;" |Category N
-| style="padding: 5px 5px; background: #F5F5F5;" |
-*Children who have no signs or symptoms considered to be the result of HIV
-*infection or who have only one of the conditions listed in Category A.
-|-
-| style="padding: 5px 5px; background: #DCDCDC;" |Category A : Mildly symptomatic
-| style="padding: 5px 5px; background: #F5F5F5;" |
-Children with two or more of the conditions listed below but none of the conditions listed in Categories B and C.
-*[[Lymphadenopathy]] (>=0.5 cm at more than two sites; bilateral = one site)
-*[[Hepatomegaly]]
-*[[Splenomegaly]]
-*[[Dermatitis]]
-*[[Parotitis]]
-*Recurrent or persistent [[upper respiratory infection]], [[sinusitis]], or [[otitis media]]
-|-
-| style="padding: 5px 5px; background: #DCDCDC;" |Category B: Moderately symptomatic
-| style="padding: 5px 5px; background: #F5F5F5;" |
-Children who have symptomatic conditions other than those listed for Category
-A or C that are attributed to HIV infection. Examples of conditions in clinical
-Category B include but are not limited to:
-*[[Anemia]] (<8 g/dL), [[neutropenia]] (<1,000/mm³), or [[thrombocytopenia]] (<100,000/mm³) persisting for at least 30 days
-*[[Bacterial meningitis]], [[pneumonia]], or [[sepsis]] (single episode)
-*[[Candidiasis]], oropharyngeal (thrush), persisting for more than 2 months in children over 6 months of age
-*[[Cardiomyopathy]]
-*[[Cytomegalovirus]] infection, with onset before 1 month of age
-*Diarrhea, recurrent or chronic
-*[[Hepatitis]]
-*[[Herpes simplex virus]] (HSV) [[stomatitis]], recurrent (more than two episodes within 1 year)
-*HSV [[bronchitis]], [[pneumonitis]], or [[esophagitis]] with onset before 1 month of age
-*[[Herpes zoster]] ([[shingles]]) involving at least two distinct episodes or more than one dermatome
-*[[Leiomyosarcoma]]
-*Lymphoid interstitial pneumonia (LIP) or pulmonary lymphoid hyperplasia complex
-*[[Nephropathy]]
-*[[Nocardiosis]]
-*Persistent fever (lasting more than 1 month)
-*[[Toxoplasmosis]], onset before 1 month of age
-*[[Varicella]], disseminated (complicated [[chickenpox]])
-|-
-| style="padding: 5px 5px; background: #DCDCDC;" |Category C: Severely symptomatic
-| style="padding: 5px 5px; background: #F5F5F5;" |
-*Serious bacterial infections, multiple or recurrent (i.e., any combination of at least two culture-confirmed infections within a 2-year period), of the following types: [[septicemia]], pneumonia, [[meningitis]], bone or joint infection, or abscess of an internal organ or body cavity (excluding otitis media, superficial skin or mucosal abscesses, and indwelling catheter-related infections)
-*Candidiasis, esophageal or pulmonary ([[bronchi]], [[Vertebrate trachea|trachea]], [[lungs]])
-*[[Coccidioidomycosis]], disseminated (at site other than or in addition to lungs or cervical or hilar [[lymph nodes]])
-*[[Cryptococcosis]], extrapulmonary
-*[[Cryptosporidiosis]] or [[isosporiasis]] with diarrhea persisting more than 1 month
-*[[Cytomegalovirus]] disease with onset of symptoms at age over 1 month (at a site other than [[liver]], [[spleen]], or lymph nodes)
-*[[Encephalopathy]] (at least one of the following progressive findings present for at least 2 months in the absence of a concurrent illness other than HIV infection that could explain the findings): a) failure to attain or loss of developmental milestones or loss of intellectual ability, verified by standard developmental scale or neuropsychological tests; b) impaired brain growth or acquired [[microcephaly]] demonstrated by head circumference measurements or brain atrophy demonstrated by computerized [[tomography]] or [[magnetic resonance imaging]] (serial imaging is required for children under 2 years of age); c) acquired symmetric motor deficit manifested by two or more of the following: [[paresis]], pathologic reflexes, [[ataxia]], or gait disturbance
-*Herpes simplex virus infection causing a mucocutaneous [[ulcer]] that persists for more than 1 month; or [[bronchitis]], [[pneumonitis]], or esophagitis for any duration affecting a child over 1 month of age
-*[[Histoplasmosis]], disseminated (at a site other than or in addition to lungs or cervical or hilar lymph nodes)
-*[[Kaposi's sarcoma]]
-*[[Lymphoma]], primary, in [[brain]]
-*Lymphoma, small, noncleaved cell ([[Burkitt's lymphoma|Burkitt's]]), or immunoblastic or large cell lymphoma of [[B-cell]] or unknown immunologic phenotype
-*[[Mycobacterium tuberculosis]], disseminated or extrapulmonary
-*Mycobacterium, other species or unidentified species, disseminated (at a site other than or in addition to lungs, skin, or cervical or hilar lymph nodes)
-*[[Mycobacterium avium complex]] or [[Mycobacterium kansasii]], disseminated (at site other than or in addition to lungs, skin, or cervical or hilar lymph nodes)
-*[[Pneumocystis carinii]] pneumonia
-*Progressive multifocal [[leukoencephalopathy]]
-*[[Salmonella]] (nontyphoid) [[septicemia]], recurrent
-*[[Toxoplasmosis]] of the brain with onset at greater than 1 month of age
-*Wasting syndrome in the absence of a concurrent illness other than HIV infection that could explain the following findings: a) persistent weight loss more than 10% of baseline OR b) downward crossing of at least two of the following percantile lines on the weight-for-age chart (e.g., 95th, 75th, 50th, 25th, 5th) in a child at least 1 year of age OR c) less than the 5th percentile on weight-for-height chart on two consecutive measurements at least 30 days apart PLUS a) chronic diarrhea (i.e., at least two loose stools per day for more than 30 days) OR b)documented fever (for at least 30 days, intermittent or constant)
-|}
-{{further|[[CDC Classification System for HIV Infection in Adults and Adolescents]]}}
-{{further|[[CDC Classification System for HIV Infection in Children]]}}
 ==References==
 {{reflist|2}}
+{{WH}}
+{{WS}}
 [[Category:HIV/AIDS]]
 [[Category:Disease]]
 [[Category:Immune system disorders]]
-[[Category:Infectious disease]]
+[[Category:Viral diseases]]
-[[category:viral diseases]]
 [[Category:Pandemics]]
 [[Category:Sexually transmitted infections]]
@@ Line 334: / Line 194: @@
 [[Category:Immunodeficiency]]
 [[Category:Microbiology]]
-{{WH}}
+[[Category:Emergency mdicine]]
-{{WS}}
+[[Category:Up-To-Date]]
+[[Category:Infectious disease]]