WHO Disease Staging System for HIV Infection and Disease in Adults and Adolescents
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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[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,[2][3][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) (The United Nations 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
- Onychomycosis (fungal nail infections)
Clinical stage 3
Conditions where a presumptive diagnosis can be made on the basis of clinical signs or simple investigations[citation needed]
- 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[citation needed]
- 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 genitalor anorectal of more than one month's duration)
- Esophageal 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
- In some cases symptoms similar to those of cold flue would be manifested.
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 zosterwithin 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 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 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.