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Staging and clinical manifestation of HIV
The document outlines the classification system and clinical staging of HIV in pediatric patients. It describes two parameters used for classification - clinical status and degree of immunologic impairment. It then lists specific clinical conditions and symptoms that are used to stage pediatric HIV infection from asymptomatic to severe, including conditions where presumptive or confirmatory diagnosis is needed. It also provides a table staging immune status based on CD4+ T-cell percentages and counts by age.
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Staging and clinical manifestation of HIV
- 1. STAGING AND CLINICAL MANIFESTATION OF HIV
- 2. HIV classificationsystem is used to categorize the stage of paediatric disease by using two parameters: clinical status degree of immunologic impairment.
- 3. REVISED WHO CLINICAL STAGING OF HIV/AIDS FOR INFANTS AND CHILDREN
- 4. Asymptomatic PGL (persistent generalized lymphadenopathy)
- 5. Hepatosplenomegaly Papular pruritic eruptions Seborrhoeic dermatitis
- 6. Extensive humanpapilloma virus infection(condyloma acuminata)
- 7. Extensive molluscumcontagiosum Fungal nail infections Recurrent or chronic RTIs (otitis media, otorrhoea, sinusitis)
- 8. Recurrent oralulcerations Linear gingival erythema (LGE) Angular cheilitis
- 9. Parotid enlargement Herpes zoster
- 10. Conditions where apresumptive 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)
- 11. Oral candidiasis(outside neonatal period ) Severe recurrent presumed bacterial pneumonia
- 12. Oral hairyleukoplakia Pulmonary TB
- 13. Acute necrotizingulcerative gingivitis/periodontitis
- 14. Conditions where confirmatorydiagnostic testing is necessary Chronic HIV-associated lung disease including brochiectasis Lymphoid interstitial pneumonitis (LIP) Unexplained anaemia (<8g/dl), and or neutropenia (<1000/mm3) and thrombocytopenia (<50 000/ mm3) for more than one month
- 15. Conditions where apresumptive 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
- 16. Recurrent severepresumed bacterial infections (e.g. empyema, pyomyositis, bone or joint infection, meningitis, but excluding pneumonia) HIV encephalopathy Extrapulmonary TB CNS toxoplasmosis (outside the neonatal period)
- 17. Chronic herpessimplex infection; (orolabial or cutaneous of more than one month’s duration)
- 18. Kaposi’s sarcoma Oesophageal candidiasis
- 19. Conditions where confirmatorydiagnostic 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)
- 20. Extrapulmonary cryptococcosisincluding meningitis Any disseminated endemic mycosis (e.g. extrapulmonary histoplasmosis, coccidiomycosis,penicilliosis) Cryptosporidiosis Isosporiasis
- 21. Disseminated non-tuberculousmycobacteria infection Progressive multifocal leukoencephalopathy (PML) Candida of trachea, bronchi or lungs HIV-associated cardiomyopathy or HIV-associated nephropathy
- 22. Visceral herpessimplex infection Acquired HIV associated rectal fistula Cerebral or B cell non-Hodgkin lymphoma
- 23. IMMUNE STATUS Age Up to 12 months 13-59 months 5 years or over Not significant immunosuppression >35% >25% >500/mm3 Mild immunosuppression 25−34% 20−24% 350−499/m m3 Advanced immunosuppression 20−24% 15−19% 200−349/m m3 Severe immunosuppression <20% <15% <200/mm3