WHO Disease Staging System for HIV Infection and Disease in Adults and Adolescents
Encyclopedia
WHO Disease Staging System for HIV Infection and Disease in Adults and Adolescents was first produced in 1990 by the World Health Organization
and updated in September 2005. It is an approach for use in resource limited settings and is widely used in Africa and Asia and has been a useful research tool in studies of progression to symptomatic HIV
disease
.
Following infection with HIV, the rate of clinical disease progression varies enormously between individuals. Many factors such as host susceptibility and immune function, health care and co-infections, as well as factors relating to the viral strain may affect the rate of clinical disease progression.
n Region version for persons aged 15 years or more who have had a positive HIV antibody test or other laboratory evidence of HIV infection)
(Tthe UN defines adolescents as persons aged 10−19 years but for surveillance purposes, the category of adults and adolescents comprises people aged 15 years and over)
Conditions where confirmatory diagnostic testing is necessary
Conditions where confirmatory diagnostic testing is necessary
Performance scale: 1: asymptomatic, normal activity.
And/or performance scale 2: symptomatic, normal activity.
And/or performance scale 3: bedridden < 50% of the day during last month.
And/or performance scale 4: bedridden > 50% of the day during last month.
(*) HIV wasting syndrome: weight loss of > 10% of body weight, plus either unexplained chronic diarrhoea (> 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.
World Health Organization
The World Health Organization is a specialized agency of the United Nations that acts as a coordinating authority on international public health. Established on 7 April 1948, with headquarters in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health...
and updated in September 2005. It is an approach for use in resource limited settings and is widely used in Africa and Asia and has been a useful research tool in studies of progression to symptomatic HIV
HIV
Human immunodeficiency virus is a lentivirus that causes acquired immunodeficiency syndrome , a condition in humans in which progressive failure of the immune system allows life-threatening opportunistic infections and cancers to thrive...
disease
Disease
A disease is an abnormal condition affecting the body of an organism. It is often construed to be a medical condition associated with specific symptoms and signs. It may be caused by external factors, such as infectious disease, or it may be caused by internal dysfunctions, such as autoimmune...
.
Following infection with HIV, the rate of clinical disease progression varies enormously between individuals. Many factors such as host susceptibility and immune function, health care and co-infections, as well as factors relating to the viral strain may affect the rate of clinical disease progression.
Revised World Health Organization (WHO) Clinical Staging of HIV/AIDS For Adults and Adolescents (2005)
(This is the interim AfricaAfrica
Africa is the world's second largest and second most populous continent, after Asia. At about 30.2 million km² including adjacent islands, it covers 6% of the Earth's total surface area and 20.4% of the total land area...
n Region version for persons aged 15 years or more who have had a positive HIV antibody test or other laboratory evidence of HIV infection)
(Tthe UN defines adolescents as persons aged 10−19 years but for surveillance purposes, the category of adults and adolescents comprises people aged 15 years and over)
Clinical stage 2
- Moderate and unexplained weight loss (<10% of presumed or measured body weight)
- Recurrent respiratory tract infections (such as sinusitisSinusitisSinusitis is inflammation of the paranasal sinuses, which may be due to infection, allergy, or autoimmune issues. Most cases are due to a viral infection and resolve over the course of 10 days...
, bronchitisBronchitisAcute bronchitis is an inflammation of the large bronchi in the lungs that is usually caused by viruses or bacteria and may last several days or weeks. Characteristic symptoms include cough, sputum production, and shortness of breath and wheezing related to the obstruction of the inflamed airways...
, otitisOtitisOtitis is a general term for inflammation or infection of the ear, in both humans and other animals.It is subdivided into the following:*Otitis externa, external otitis, or "swimmer's ear" involves the outer ear and ear canal. In external otitis, the ear hurts when touched or pulled.*Otitis media...
media, pharyngitisPharyngitisPharyngitis is an inflammation of the throat or pharynx. In most cases it is quite painful, and is the most common cause of a sore throat.Like many types of inflammation, pharyngitis can be acute – characterized by a rapid onset and typically a relatively short course – or chronic....
) - Herpes zosterHerpes zosterHerpes zoster , commonly known as shingles and also known as zona, is a viral disease characterized by a painful skin rash with blisters in a limited area on one side of the body, often in a stripe...
- Recurrent oral ulcerations
- Papular pruritic eruptions
- Angular cheilitis
- Seborrhoeic dermatitis
- Fungal finger nail infections
Clinical stage 3
Conditions where a presumptive diagnosis can be made on the basis of clinical signs or simple investigations- Unexplained chronic diarrhoea for longer than one month
- Unexplained persistent fever (intermittent or constant for longer than one month)
- Severe weight loss (>10% of presumed or measured body weight)
- Oral candidiasisCandidiasisThrush redirects here. For the hoof infection see Thrush .Candidiasis or thrush is a fungal infection of any of the Candida species , of which Candida albicans is the most common...
- Oral hairy leukoplakiaLeukoplakiaLeukoplakia is a clinical term used to describe patches of keratosis. It is visible as adherent white patches on the mucous membranes of the oral cavity, including the tongue, but also other areas of the gastro-intestinal tract, urinary tract and the genitals. The clinical appearance is highly...
- Pulmonary tuberculosis (TB) diagnosed in last two years
- Severe presumed bacterial infections (e.g. pneumonia, empyema, meningitis, bacteraemia, pyomyositis, bone or joint infection)
- Acute necrotizing ulcerative stomatitis, gingivitis or periodontitis
Conditions where confirmatory diagnostic testing is necessary
- Unexplained anaemia (< 80 g/l), and or neutropenia (<500/µl) and or thrombocytopenia (<50 000/ µl) for more than one month
Clinical stage 4
Conditions where a presumptive diagnosis can be made on the basis of clinical signs or simple investigations- HIV wasting syndrome
- Pneumocystis pneumonia
- Recurrent severe or radiological bacterial pneumonia
- Chronic herpes simplex infection (orolabial, genital or anorectal of more than one month’s duration)
- Oesophageal candidiasis
- Extrapulmonary Tuberculosis
- Kaposi’s sarcoma
- Central nervous system toxoplasmosis
- HIV encephalopathy
Conditions where confirmatory diagnostic testing is necessary
- Extrapulmonary cryptococcosis including meningitis
- Disseminated non-tuberculous mycobacteria infection
- Progressive multifocal leukoencephalopathy
- Candida of trachea, bronchi or lungs
- Cryptosporidiosis
- Isosporiasis
- Visceral herpes simplex infection
- Cytomegalovirus (CMVCMVCMV is a three-letter abbreviation with multiple meanings, as described below:* Calima Aviación, ICAO airline designator* Cauliflower mosaic virus, although more commonly abbreviated as CaMV...
) infection (retinitis or of an organ other than liver, spleen or lymph nodes) - Any disseminated mycosis (e.g. histoplasmosis, coccidiomycosis, penicilliosis)
- Recurrent non-typhoidal salmonella septicaemia
- Lymphoma (cerebral or B cell non-Hodgkin)
- Invasive cervical carcinoma
- Visceral leishmaniasis
Clinical Stage I
- Asymptomatic
- Generalised lymphadenopathy
Performance scale: 1: asymptomatic, normal activity.
Clinical Stage II
- Weight loss, < 10% of body weight
- Minor mucocutaneous manifestations (seborrheic dermatitis, prurigoPrurigoPrurigo is a general term used to describe itchy eruptions of the skin.Specific types include:* Prurigo nodularis* Actinic prurigo* Besnier's prurigo ....
, fungal nail infections, recurrent oral ulcerations, angular cheilitis) - Herpes zosterHerpes zosterHerpes zoster , commonly known as shingles and also known as zona, is a viral disease characterized by a painful skin rash with blisters in a limited area on one side of the body, often in a stripe...
within the last five years - Recurrent upper respiratory tract infections (i.e. bacterial sinusitis)
And/or performance scale 2: symptomatic, normal activity.
Clinical Stage III
- Weight loss, > 10% of body weight
- Unexplained chronic diarrhoea > 1 month
- Unexplained prolonged fever (intermittent or constant), > 1 month
- Oral [candidiasis] ([thrush])
- Oral hairy leucoplakia
- Pulmonary tuberculosisTuberculosisTuberculosis, MTB, or TB is a common, and in many cases lethal, infectious disease caused by various strains of mycobacteria, usually Mycobacterium tuberculosis. Tuberculosis usually attacks the lungs but can also affect other parts of the body...
- Severe bacteriaBacteriaBacteria are a large domain of prokaryotic microorganisms. Typically a few micrometres in length, bacteria have a wide range of shapes, ranging from spheres to rods and spirals...
l infections (i.e. pneumoniaPneumoniaPneumonia is an inflammatory condition of the lung—especially affecting the microscopic air sacs —associated with fever, chest symptoms, and a lack of air space on a chest X-ray. Pneumonia is typically caused by an infection but there are a number of other causes...
, pyomyositisPyomyositisPyomyositis, also known as tropical pyomyositis or myositis tropicans, is a bacterial infection of the skeletal muscles which results in a pus-filled abscess. Pyomyositis is most common in tropical areas but can also occur in temperate zones....
)
And/or performance scale 3: bedridden < 50% of the day during last month.
Clinical Stage IV
The declaration of AIDS- HIV wasting syndrome *
- Pneumocystis carinii pneumonia
- ToxoplasmosisToxoplasmosisToxoplasmosis is a parasitic disease caused by the protozoan Toxoplasma gondii. The parasite infects most genera of warm-blooded animals, including humans, but the primary host is the felid family. Animals are infected by eating infected meat, by ingestion of feces of a cat that has itself...
of the brain - CryptosporidiosisCryptosporidiosisCryptosporidiosis, also known as crypto, is a parasitic disease caused by Cryptosporidium, a protozoan parasite in the phylum Apicomplexa. It affects the intestines of mammals and is typically an acute short-term infection...
with diarrhoea > 1 month - CryptococcosisCryptococcosisCryptococcosis, or cryptococcal disease, is a potentially fatal fungal disease. It is caused by one of two species; Cryptococcus neoformans and Cryptococcus gattii. These were all previously thought to be subspecies of C...
, extrapulmonary - CytomegalovirusCytomegalovirusCytomegalovirus is a viral genus of the viral group known as Herpesviridae or herpesviruses. It is typically abbreviated as CMV: The species that infects humans is commonly known as human CMV or human herpesvirus-5 , and is the most studied of all cytomegaloviruses...
disease of an organ other than liverLiverThe liver is a vital organ present in vertebrates and some other animals. It has a wide range of functions, including detoxification, protein synthesis, and production of biochemicals necessary for digestion...
, spleenSpleenThe spleen is an organ found in virtually all vertebrate animals with important roles in regard to red blood cells and the immune system. In humans, it is located in the left upper quadrant of the abdomen. It removes old red blood cells and holds a reserve of blood in case of hemorrhagic shock...
or lymph nodeLymph nodeA lymph node is a small ball or an oval-shaped organ of the immune system, distributed widely throughout the body including the armpit and stomach/gut and linked by lymphatic vessels. Lymph nodes are garrisons of B, T, and other immune cells. Lymph nodes are found all through the body, and act as...
(ex: retinitis) - Herpes simplex virusHerpes simplex virusHerpes simplex virus 1 and 2 , also known as Human herpes virus 1 and 2 , are two members of the herpes virus family, Herpesviridae, that infect humans. Both HSV-1 and HSV-2 are ubiquitous and contagious...
infection, mucocutaneous (>1 month) or visceral - Progressive multifocal leucoencephalopathy
- Any disseminated endemic mycosis
- CandidiasisCandidiasisThrush redirects here. For the hoof infection see Thrush .Candidiasis or thrush is a fungal infection of any of the Candida species , of which Candida albicans is the most common...
of esophagus, trachea, bronchi - Atypical mycobacteriosis, disseminated or lungs
- Non-typhoid SalmonellaSalmonellaSalmonella is a genus of rod-shaped, Gram-negative, non-spore-forming, predominantly motile enterobacteria with diameters around 0.7 to 1.5 µm, lengths from 2 to 5 µm, and flagella which grade in all directions . They are chemoorganotrophs, obtaining their energy from oxidation and reduction...
septicemia - Extrapulmonary tuberculosis
- LymphomaLymphomaLymphoma is a cancer in the lymphatic cells of the immune system. Typically, lymphomas present as a solid tumor of lymphoid cells. Treatment might involve chemotherapy and in some cases radiotherapy and/or bone marrow transplantation, and can be curable depending on the histology, type, and stage...
- Kaposi's sarcomaKaposi's sarcomaKaposi's sarcoma is a tumor caused by Human herpesvirus 8 , also known as Kaposi's sarcoma-associated herpesvirus . It was originally described by Moritz Kaposi , a Hungarian dermatologist practicing at the University of Vienna in 1872. It became more widely known as one of the AIDS defining...
- HIV encephalopathy **
And/or performance scale 4: bedridden > 50% of the day during last month.
(*) HIV wasting syndrome: weight loss of > 10% of body weight, plus either unexplained chronic diarrhoea (> 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.