HIV pediatric classification system
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-In-Chief: Ujjwal Rastogi, M.B.B.S. [2]
Overview
Additional knowledge of the progression of HIV disease among children lead to the development of revised classification system for HIV infection in children in 1994 which replaced the pediatric HIV classification system that was published earlier in 1987.
Pediatric Classification System
| 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 following conditions 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 Category C, that are attributed to HIV infection. Examples of conditions in Clinical Category B include, but are not limited to, the following: |
| Anemia (<8 gm/dL), neutropenia (<1,000 cells/mm3), or thrombocytopenia (<100,000 cells/mm3) persisting ≥30 days. |
| Bacterial meningitis, pneumonia, or sepsis (single episode) |
| Candidiasis, oropharyngeal (i.e., thrush) persisting for >2 months in children age >6 months |
| Cardiomyopathy |
| Cytomegalovirus infection with onset before age 1 month |
| Diarrhea, recurrent or chronic |
| Hepatitis |
| Herpes simplex virus (HSV) stomatitis, recurrent (i.e., more than two episodes within 1 year) |
| HSV bronchitis, pneumonitis, or esophagitis with onset before age 1 month |
| Herpes zoster (i.e., shingles) involving at least two distinct episodes or more than one dermatome |
| Leiomyosarcoma |
| Lymphoid interstitial pneumonia (LIP) or pulmonary lymphoid hyperplasia complex |
| Nocardiosis |
| Fever lasting >1 month |
| Toxoplasmosis with onset before age 1 month |
| Varicella, disseminated (i.e., complicated chickenpox) |
| Category C: Severely Symptomatic |
| Children who have any condition listed in the 1987 surveillance case definition for acquired immunodeficiency syndrome (below), with the exception of LIP (which is a Category B condition): |
| 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, 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 >1 month |
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)
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| Herpes simplex virus infection causing a mucocutaneous ulcer that persists for >1 month or bronchitis, pneumonitis, or esophagitis for any duration affecting a child >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), 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 jiroveci pneumonia |
| Progressive multifocal leukoencephalopathy |
| Salmonella (nontyphoid) septicemia, recurrent |
| Toxoplasmosis of the brain with onset at >1 month of age |
Wasting syndrome in the absence of a concurrent illness other than HIV infection that could explain the following findings:
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