HIV AIDS classification

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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, 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 (CDC) Classification System for HIV/AIDS is another primary system used.

Classification

WHO Staging System for HIV Infection and Disease in Adults and Adolescents

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

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 for HIV Infection

• 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.
• They also used Kaposi's Sarcoma and Opportunistic Infections, the name by which a task force had been set up in 1981.
• In the general press, the term GRID, which stood for Gay-related immune deficiency, had been coined.
• However, after determining that AIDS was not isolated to the homosexual community, the term GRID became misleading and AIDS was introduced at a meeting in July 1982.
• By September 1982 the CDC started using the name AIDS, and properly defined the illness.
• In 1993, the CDC expanded their definition of AIDS to include all HIV positive people with a CD4⁺ T cell count below 200 per µL of blood or 14% of all lymphocytes.
• 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⁺ 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.

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.