Clinical Overview of HIV Disease

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Table 3: WHO Staging System for HIV Infection and Disease in Adults and Adolescents

The 3 CD4 count categories *

Clinical stage I

1. Asymptomatic
2. Persistent generalized lymphadenopathy
   Performance scale 1: asymptomatic, normal activity/

Clinical stage II

3. Weight loss, <10% of body weight
4. Minor mucocutaneous manifestations (seborrheic dermatitis, prurigo, fungal nail infections, recurrent oral ulcerations, angular cheilitis)
5. Herpes zoster within the last 5 years
6. Recurrent upper respiratory tract infections (ie, bacterial sinusitis)
   And/or performance scale 2: symptomatic, normal activity

Clinical stage III

7. Weight loss, >10% of body weight
8. Unexplained chronic diarrhoea, >1 month
9. Unexplained prolonged fever (intermittent or constant), >1 month
10. Oral candidiasis (thrush)
11. Oral hairy leukoplakia
12. Pulmonary tuberculosis within the past year
13. Severe bacterial infections (ie, pneumonia, pyomyositis)
    And/or performance scale 3: bedridden <50% of the day during the last month

Clinical stage IV

14. HIV wasting syndrome, as defined by the U.S. Centers for Disease Control and Prevention (CDC)*
15. Pneumocystis jiroveci (formerlycarinii) pneumonia
16. Toxoplasmosis of the brain
17. Cryptosporidiosis with diarrhea >1 month
18. Cryptococcosis, extrapulmonary
19. Cytomegalovirus disease of an organ other than liver, spleen, or lymph nodes
20. Herpes simplex virus infection, mucocutaneous >1 month, or visceral any duration
21. Progressive multifocal leukoencephalopathy
22. Any disseminated endemic mycosis (ie, histoplasmosis, coccidioidomycosis)
23. Candidiasis of the esophagus, trachea, bronchi, or lungs
24. Atypical mycobacteriosis, disseminated
25. NontyphoidSalmonella septicemia
26. Extrapulmonary tuberculosis
27. Lymphoma
28. Kaposi sarcoma
29. HIV encephalopathy, as defined by the CDC#
    And/or performance scale 4: bedridden >50% of the day during the last month

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(a) Proposed 'World Health Organization staging system for HIV infection and disease': preliminary testing by an international collaborative cross-sectional study. The WHO International Collaborating Group for the Study of the WHO Staging System. AIDS 1993 May;7(5):711-8.

Note: both definitive and presumptive diagnoses are acceptable.

*HIV wasting syndrome: weight loss of >10% of body weight, plus either unexplained chronic diarrhea (>1 month) or chronic weakness and unexplained prolonged fever (>1 month).

#HIV encephalopathy: clinical findings of disabling cognitive and/or motor dysfunction interfering with activities of daily living, progressing over weeks to months, in the absence of a concurrent illness or condition other than HIV infection which could explain the findings.

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