View source for CDC Classification System for HIV Infection in Children

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{{CMG}}
==Overview==
Due to the additional knowledge of the progression of [[HIV]] disease among children, a revised classification system for HIV infection in children was developed in [[1994]] that replaced the pediatric HIV classification system that was published in [[1987]]. A child for the purposes of the [[Centers for Disease Control and Prevention|CDC]] is an individual of less than 13 years of age. Standard anti-HIV IgG [[antibody]] tests cannot be used to reliably indicate a child's infection status before 18 months of age, so viral [[antigen]] tests are used.

==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. 

==Category N: Not symptomatic==

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.

==Category A: Mildly symptomatic==

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]]

==Category B: Moderately symptomatic==

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]])

==Category C: Severely symptomatic==

*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)

[[Category:HIV/AIDS]]
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