Criteria

World Health Organization staging[65]

Stage 1

  • Acute seroconversion syndrome: there is no current case definition for acute seroconversion illness, although an acute viral syndrome in the early stages of HIV is well recognized. Primary infection usually presents within the first month of exposure to HIV and commonly presents with a fever and lymphadenopathy. Other clinical symptoms and signs might include pharyngitis, maculopapular rash, orogenital ulcers, or meningoencephalitis. Other opportunistic infections may occur, due to the transient lymphopenia. The CD4 count may drop profoundly. Diagnosis is made by observing the appearance of an HIV antibody (serial rapid tests or enzyme-linked immunosorbent assay [ELISA] or by noting the presence of HIV, using HIV-RNA or HIV-DNA and/or ultrasensitive HIV p24 antigen with an absent HIV antibody)[4][21]

  • Persistent generalized lymphadenopathy (painless enlarged nodes, in 2 or more noncontiguous sites of more than 1 cm for more than 3 months)

  • Asymptomatic, that is, no symptoms reported that might be related to HIV/AIDS

  • Performance status 1 (fully active and asymptomatic).

Stage 2

  • Weight loss of less than 10% of body weight

  • Herpes zoster (shingles)

  • Minor mucocutaneous manifestations

  • Recurrent upper respiratory tract infections

  • Performance status 2 (symptomatic but near fully active).

Stage 3

  • Weight loss of more than 10% of body weight

  • Chronic diarrhea for more than 1 month

  • Prolonged fever for more than 1 month

  • Oral candida, chronic vaginal candidiasis

  • Oral hairy leukoplakia

  • Severe bacterial infections

  • Pulmonary tuberculosis (TB)

  • Performance status 3 (in bed less than 50% of past month).

Stage 4

  • Extrapulmonary TB

  • Pneumocystis jirovecii pneumonia

  • Cryptococcal meningitis

  • Herpes simplex virus ulcer for more than 1 month

  • Esophageal or pulmonary candidiasis

  • Toxoplasmosis

  • Cryptosporidiosis

  • Isosporiasis

  • Cytomegalovirus

  • HIV wasting syndrome

  • HIV encephalopathy

  • Kaposi sarcoma

  • Progressive multifocal leukoencephalopathy

  • Disseminated mycosis

  • Atypical mycobacteriosis

  • Nontyphoid salmonella bacteremia

  • Lymphoma

  • Recurrent pneumonia

  • Invasive cervical carcinoma

  • Performance status 4 (confined to bed more than 50% of the time).

Advanced HIV disease[72]

  • CD4 cell count <200 cells/mm³, or stage 3 or 4 event at presentation in adults, adolescents, and children ≥5 years of age. All children <5 years of age should be considered as having advanced disease at presentation.

  • Seriously ill adult or adolescent: respiratory rate ≥30 breaths per minute, heart rate ≥120 bpm, unable to walk unaided, or body temperature ≥102.2F° (≥39°C).

  • Seriously ill child: lethargy or unconsciousness, convulsions, unable to drink/breastfeed, repeated vomiting, tachycardia or tachypnea, or body temperature ≥102.2F° (≥39°C).

  • Severely immunosuppressed: CD4 cell count <50 cells/mm³.

Centers for Disease Control and Prevention case severity[64]

Note that the CD4+ T-lymphocyte count takes precedence over the CD4+ T-lymphocyte percentage in HIV infection stages 1, 2, and 3. The CD4+ T-lymphocyte percentage should only be considered if the count is missing.

HIV infection, stage 0

  • Indicates early HIV infection, inferred from a negative or indeterminate HIV test result within 180 days of a positive result. The criteria for stage 0 supersede and are independent of criteria used for other stages.

HIV infection, stage 1 (≥6 years)

  • Laboratory confirmation of HIV infection with no AIDS-defining condition, and

    • CD4+ T-lymphocyte count of ≥500 cells/microliter, or

    • CD4+ T-lymphocyte percentage of total lymphocytes of ≥26%.

HIV infection, stage 2 (≥6 years)

  • Laboratory confirmation of HIV infection with no AIDS-defining condition, and

    • CD4+ T-lymphocyte count of 200 to 499 cells/microliter, or

    • CD4+ T-lymphocyte percentage of total lymphocytes of 14% to 25%.

HIV infection, stage 3 (AIDS; ≥6 years)

  • Laboratory confirmation of HIV infection, and

    • CD4+ T-lymphocyte count of <200 cells/microliter, or

    • CD4+ T-lymphocyte percentage of total lymphocytes of <14% or

    • Documentation of an AIDS-defining condition.

    Documentation of an AIDS-defining condition supersedes a CD4+ T-lymphocyte count of >200 cells/microliter and a CD4+ T-lymphocyte percentage of total lymphocytes of >14%.

HIV infection, stage unknown

  • Laboratory confirmation of HIV infection, and

    • No information on CD4+ T-lymphocyte count or percentage, and

    • No information on presence of AIDS-defining conditions.

Stage-3-defining opportunistic illnesses in HIV infection

  • Bacterial infections, multiple or recurrent (only among children ages <6 years)

  • Candidiasis of bronchi, trachea, or lungs

  • Candidiasis of esophagus

  • Cervical cancer, invasive (only among adults, adolescents, and children ages ≥6 years)

  • Coccidioidomycosis, disseminated or extrapulmonary

  • Cryptococcosis, extrapulmonary

  • Cryptosporidiosis, chronic intestinal (>1 month's duration)

  • Cytomegalovirus disease (other than liver, spleen, or nodes), onset at age >1 month

  • Cytomegalovirus retinitis (with loss of vision)

  • Encephalopathy, HIV-related

  • Herpes simplex: chronic ulcers (>1 month's duration) or bronchitis, pneumonitis, or esophagitis (onset at age >1 month)

  • Histoplasmosis, disseminated or extrapulmonary

  • Isosporiasis, chronic intestinal (>1 month's duration)

  • Kaposi sarcoma

  • Lymphoma, Burkitt (or equivalent term)

  • Lymphoma, immunoblastic (or equivalent term)

  • Lymphoma, primary, of brain

  • Mycobacterium avium complex or Mycobacterium kansasii, disseminated or extrapulmonary

  • Mycobacterium tuberculosis of any site, pulmonary (only among adults, adolescents, and children ages ≥6 years), disseminated, or extrapulmonary

  • Mycobacterium, other species or unidentified species, disseminated or extrapulmonary

  • Pneumocystis jirovecii pneumonia

  • Pneumonia, recurrent (only among adults, adolescents, and children ages ≥6 years)

  • Progressive multifocal leukoencephalopathy

  • Salmonella septicemia, recurrent

  • Toxoplasmosis of brain, onset at age >1 month

  • Wasting syndrome attributed to HIV.

Profiles of disease progression

Rapid progressors: a small proportion of individuals develop AIDS within 1 to 2 years. This is associated with high levels of viral replication and a precipitous decline in CD4 numbers.

Long-term controllers: a small proportion of individuals are able to control HIV viral load without assistance of antiretroviral therapy. Many have low to undetectable viral loads and well-preserved CD4 counts for many years. This appears in part to be due to a robust immunity to HIV.

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