Clinical Overview of HIV Disease

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Table 2: CDC Categorization of HIV / AIDS

The 3 CD4 count categories *

Category 1  >=500 cells/µL or more
Category 2  200-499 cells/µL
Category 3  <200 cells/µL

The 3 clinical categories

Category A
One or more of the conditions listed below in an adolescent or adult (aged 13 years or older) with documented HIV infection. Conditions listed in categories B and C must not have occurred.

• asymptomatic HIV infection
• persistent generalized lymphadenopathy (PGL)
• acute (primary) HIV infection with accompanying illness (sometimes known as seroconversion illness) or history of acute HIV infection

Category B *
Consists of symptomatic conditions in an HIV-infected adolescent or adult that are not included among conditions listed in category C and that meet one of the following criteria:

• the conditions are attributed to HIV infection or are indicative of a defect in cell-mediated immunity, or
• the conditions are considered by physicians to have a clinical course or to require management that is complicated by HIV infection

(This category includes all such symptomatic conditions, with the exception of those placed in category C. Examples of conditions in this category include, but are not limited to: bacillary angiomatosis, candidiasis (thrush) in the mouth and/or upper throat, candidiasis of the vagina and/or vulva which is persistent, frequent, or responds poorly to treatment, cervical abnormalites of moderate or severe extent or cervical cancer, constitutional symptoms such as fever (38.5°C) or diarrhea lasting longer than 1 month, herpes zoster (shingles) involving at least 2 distinct episodes or more than 1 dermatone (skin area), idiopathic thrombocytopenia purpura, listeriosis, oral hairy leukoplakia, pelvic inflammatory disease, particularly if complicated by tubo-ovarian abscess, peripheral neuropathy

Category C #
Includes the following conditions listed in the AIDS surveillance case definition.

• Candida in the esophagus, trachea, bronchi, or lungs
• invasive cervical cancer
• coccidioidomycosis
• Cryptococcus outside the lungs
• cryptosporidiosis with diarrhea lasting for >1 month
• CMV disease outside the liver, spleen, or lymph nodes
• CMV retinitisherpes simplex virus causing prolonged skin problems or involving the lungs or esophagus
• HIV-related encephalopathy
• chronic intestinal isosporiasis lasting >1 month
• Kaposi sarcoma
• Burkitt, immunoblastic, or primary (ie, not involving other parts of the body) brain lymphoma
• Widespread Mycobacterium avium intracellulare (MAI), M kansasii , or other species
• Pneumocystis jiroveci (formerly carinii ) pneumonia (PCP)
• recurrent bacterial pneumonia
• progressive multifocal leukoencephalopathy (PML)
• recurrent Salmonella septicemia
• toxoplasmosis of the brain
• HIV wasting syndrome

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(a) Centers for Disease Control. 1993 Revised classification system for HIV infection and expanded surveillance case definition for AIDS among adolescents and adults. MMWR Morb Mort Wkly Rep 1992; 41(RR-17):1-19.

* For classification purposes, category B conditions take precedence over those in category A. For example, a patient previously treated for oral or persistent vaginal candidiasis (and who has not developed a category C disease) but who is now asymptomatic should be classified in clinical category B.

# For classification purposes, once a category C condition has occurred, the person will remain in category C.

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C. Bradley Hare, MD, University of California San Francisco
January 2006
From the HIV InSite Knowledge Base