HIV AIDS classification: Difference between revisions

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VisualWikitext

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==
-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.
+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 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
- cite journal
- | 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.
-* Stage I: HIV infection is [[asymptomatic]] and not categorized as AIDS
-* Stage II: includes minor [[Mucous membrane|mucocutaneous]] manifestations and recurrent [[upper respiratory tract]] infections
-* 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
-* 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.
-===WHO staging system for HIV [[infection]] and disease in adults and adolescents<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>===
-{| style="border: 0px; font-size: 90%; margin: 3px;" align=center
 ! style="background: #4479BA; width: 120px;" | {{fontcolor|#FFF|Clinical stage}}
 ! style="background: #4479BA; width: 550px;" | {{fontcolor|#FFF|Features}}
@@ Line 43: / Line 27: @@
 *Papular pruritic eruptions
 *Angular cheilitis
-*[[Seborrhoeic]] [[dermatitis]]
+*Seborrhoeic [[dermatitis]]
 *Fungal [[finger nail]] [[infections]]
 |-
@@ Line 92: / 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="border: 0px; font-size: 90%; margin: 3px;" align=center
 ! style="background: #4479BA; width: 120px;" | {{fontcolor|#FFF|Clinical stage}}
 ! style="background: #4479BA; width: 550px;" | {{fontcolor|#FFF|Features}}
@@ Line 106: / 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 146: / 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 159: / 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 168: / Line 151: @@
 |}
-===CDC Classification System for HIV Infection===
+==CDC Classification System==
-{{main|CDC Classification System for HIV Infection}}
+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>
-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>{{
+{{#widget:BlueTable}}
+{|class="BlueTable" style="width: 500px"
- cite journal
+!rowspan=3|Stage*
- | author=Centers for Disease Control (CDC)
+!colspan=6|Age on date of CD4 T-lymphocyte test
- | title=Persistent, generalized lymphadenopathy among homosexual males.
+|-
- | journal=MMWR Morb Mortal Wkly Rep. | year=1982 | pages=249&ndash;251 | volume=31| issue=19
+! colspan=2|<1 year
- | pmid=6808340
+! colspan=2|1—5 years
+! colspan=2|6 years through adult
-}}</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>{{
+! Cells/µL||%||Cells/µL||%||Cells/µL||%
+|-
- cite journal
+| 1||≥1,500||≥34||≥1,000||≥30||≥500||≥26
- | author=Centers for Disease Control (CDC)
+|-
- | title=Opportunistic infections and Kaposi's sarcoma among Haitians in the United States
+| 2||750—1,499||26—33||500—999||22—29||200—499||14—25
- | journal=MMWR Morb Mortal Wkly Rep. | year=1982 | pages=353&ndash;354; 360&ndash;361 | volume=31 | issue=26
+|-
- | pmid=6811853
+| 3||<750||<26||<500||<22||<200||<14
-}}</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.
-==Comparison Between AIDS and HIV==
-The following tables compares AIDS and HIV:
-<center>
-{| class="wikitable" cellpadding=5
-| Parameter || '''[[AIDS]]''' || '''[[HIV]]'''
-|-
-| Definition || Most advance stage of HIV disease. A CD4 count of fewer than 200 cells/mm3 is one of the qualifications for a diagnosis of AIDS. It occurs when weakened [[immune system]] of the patient, due to Human Immunodeficiency Virus , developes one or more [[opportunistic infections]]. || HIV is a virus, harming the body’s immune system by attacking [[helper T cells]] or [[CD4]] cells.
-|-
-| Spread of infection  ||  Only patients with HIV can develop AIDS || HIV can be spread through various ways; most notable being sexual intercourse, the exchange of certain body fluids  ([[blood]], [[pre-ejaculate]], [[semen]], [[vaginal]] secretions, and [[breast milk]]).
 |-
-| Treatment || [[Antiretroviral drug|ART]] has only proved to be palliative rather being curative ||  [[Antiretroviral drug|ART]] can slow the progression from HIV to AIDS, and increase survival. Some researches have claimed to cure the disease <ref name="pmid19213682">{{cite journal |author=Hütter G, Nowak D, Mossner M, Ganepola S, Müssig A, Allers K, Schneider T, Hofmann J, Kücherer C, Blau O, Blau IW, Hofmann WK, Thiel E |title=Long-term control of HIV by CCR5 Delta32/Delta32 stem-cell transplantation |journal=N. Engl. J. Med. |volume=360 |issue=7 |pages=692–8 |year=2009 |month=February|pmid=19213682 |doi=10.1056/NEJMoa0802905 |url=http://dx.doi.org/10.1056/NEJMoa0802905 |accessdate=2012-03-02}}</ref>, while others have a different opinion.<ref name="pmid19213687">{{cite journal |author=Levy JA |title=Not an HIV cure, but encouraging new directions |journal=N. Engl. J. Med. |volume=360 |issue=7 |pages=724–5 |year=2009 |month=February |pmid=19213687 |doi=10.1056/NEJMe0810248 |url=http://www.nejm.org/doi/abs/10.1056/NEJMe0810248?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed |accessdate=2012-03-02}}</ref>
+|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>
 |}
-</center>
-===Summary===
-HIV virus can cause AIDS. However not everyone who is infected with HIV develops AIDS. HIV infected patients can live for years without developing AIDS symptoms.
 ==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 254: / Line 194: @@
 [[Category:Immunodeficiency]]
 [[Category:Microbiology]]
-{{WH}}
+[[Category:Emergency mdicine]]
-{{WS}}
+[[Category:Up-To-Date]]
+[[Category:Infectious disease]]