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WHO Staging of HIV and AIDS.ppt
- 1. Staging for HIVInfection Wilson Okumu
- 2. 2 Learning Outcomes • Bythe end of this session, you will be expected to be able to: • Discuss disease staging and AIDS-defining illness based on WHO guidelines
- 3. 3 What is Staging? •Classification of the particular stage reached by a progressive disease
- 4. 4 Why is StagingImportant in HIV? • Tracking and monitoring the HIV epidemic • Providing clinicians and patients with important information about HIV disease stage and clinical management
- 5. 5 What are theStaging Systems in use? (1) U.S. Centers for Disease Control and Prevention (CDC) classification system (2) World Health Organization (WHO) Clinical Staging and Disease Classification System
- 6. 6 We will focuson WHO clinical staging systems
- 7. 7 Phases of HIVdisease
- 8. 8 Three Phases ofHIV Infection • Course taken by HIV is understood in terms of interplay between HIV and the immune system.
- 9. 9 Phase I-The early,acute phase • Initial response of an immunocompetent adult to HIV infection • High level of virus production and viraemia widespread viral seeding of the lymphoid tissues and 1-2 billion CD4+ T-cells die each day • Clinically characterized by infectious mononucleosis- like features of sore throat, myalgias, fever, weight loss, and fatigue
- 10. 10 Phase II-The middle,Chronic Phase • Relative containment of the virus and clinical latency • Virus replication continues for several years, • predominantly in the lymphoid tissues • Immune system largely intact • Clinically, patients are either asymptomatic or develop persistent generalized lymphadenopathy (PGL). • Many patients have herpes zoster, oral thrush 21
- 11. 11 Phase III-The FinalPhase • Breakdown of host defense • CD4 count usually < 200 cells/mm3 • Sudden and rapid viraemia • Clinically, the patient presents with marked weight loss, • Chronic diarrhoea, and fever lasting more than 1 month • Opportunistic infections (OI) occur • The clinical picture of AIDS will depend on the type of OI 22
- 12. 12 Phase of HIVand AIDS • Four phases emerge from day zero –Infection –Window period –Seroconversion –Asymptomatic period –HIV/AIDS - related illness • AIDS
- 13. 13 CD4 Counts • Numberof CD4 cells in blood provides a measure of immune system damage • CD4 count reflects phase of disease • CD4 count: –500 – 1200: Normal –200 – 500: Beginning of HIV illness –< 200: AIDS
- 14. 14 Window Period • Timebetween infection & enough antibodies for a positive HIV test • Duration: approximately 3 months • No symptoms or signs of illness • HIV test is negative • Virus is multiplying rapidly - viral load is high • Person is very infectious
- 15. 15 Seroconversion • Point atwhich HIV test becomes positive • Body starts making antibodies to HIV a few weeks after infection • HIV test becomes positive when antibody levels are high enough to be measured • Happens about 3 months after infection • Person may have a mild flu-like illness, lasting a week or two then the person is well again
- 16. 16 Asymptomatic Periodic • Timeperiod between seroconversion and onset of HIV/AIDS-related illness • Duration variable: < 1 year to > 15 years • Most people remain healthy (asymptomatic) for about three years • Duration may depend on socio-economic factors • The CD4 count is above 500 cells/ml
- 17. 17 HIV-Related Illnesses &AIDS • Time period between onset of illness & diagnosis of AIDS • Duration is variable: average about 5 years • Illnesses initially mild, with gradual increase in frequency and severity • CD4 count is between 500 & 200 cells/ml
- 18. 18 AIDS • Final phaseof HIV/AIDS • Duration: without antiretroviral drugs, less than 2 years with and with antiretrovirals, many many years • CD4 count is below 200 cells/ml • Viral loads are high & the person is very infectious • HIV test may become negative
- 19. 19 WHO Clinical Stagingof HIV/AIDS
- 20. 20 WHO Clinical Stagingin Adults Adults with HIV infection are classified into 4 clinical stages depending on the presence of HIV-related conditions
- 21. 21 WHO Clinical StagingCriteria? Classification WHO clinical stage Asymptomatic 1 Mild 2 Advanced 3 Severe 4
- 22. WHO Clinical Stage1- Primary HIV Infection • Asymptomatic • Persistent Generalized Lymphadenopathy (PGL) • Performance scale 1: asymptomatic, normal activity
- 23. WHO Clinical StageII-Asymptomatic • Weight loss, <10% of body weight • Minor mucocutaneous manifestations (seborrheic dermatitis, prurigo, • Fungal nail infections, recurrent oral ulcerations, angular cheilitis • Herpes zoster within the last five years • Recurrent upper respiratory tract infections • And/or performance scale 2: symptomatic, normal activity.
- 24. WHO Clinical StageIII- Asymptomatic 24
- 25. WHO Clinical StageIV-(HIV to AIDS) • HIV wasting syndrome, as defined by the Centers for Disease Control and Prevention • Pneumocystis carinii pneumonia • Toxoplasmosis of the brain • Cryptosporidiosis with diarrhoea >1 month • Cryptococcosis, extrapulmonary • Cytomegalovirus disease of an organ other than liver, spleen or lymph nodes • Herpes simplex virus infection, mucocutaneous >1 month, or visceral any duration • Progressive multifocal leukoencephalopathy
- 26. 26 WHO Clinical StageIV- (HIV to AIDS) • Any disseminated endemic mycosis (i.e.histoplasmosis, coccidioidomycosis) • Candidiasis of the oesophagus, trachea, bronchi or lungs • Atypical mycobacteriosis, disseminated • Non-typhoid Salmonella septicaemia • Extrapulmonary tuberculosis • Lymphoma • Kaposi’s sarcoma • HIV encephalopathy, as defined by the Centers for Disease Control and Prevention. • And/or performance scale 4: bedridden >50% of the day during the last month 32
- 27. 27 References Cited • WHOCase Definitions of HIV for Surveillance and Revised Clinical Staging and Immunological Classification of HIV-Related Disease in Adults and Children; 2007. • 1993 revised classification system for HIV infection and expanded surveillance case definition for AIDS among adolescents and adults. MMWR Recomm Rep. 1992 Dec 18;41(RR-17):1-19. • Guidelines for national human immunodeficiency virus case surveillance, including monitoring for human immunodeficiency virus infection and acquired immunodeficiency syndrome. MMWR Recomm Rep. 1999 Dec 10;48(RR-13):1-27, 29-31.