WHO Disease Staging System for HIV Infection and Disease in Adults and Adolescents
From Wikipedia the free encyclopedia
 | This article needs more reliable medical references for verification or relies too heavily on primary sources. (April 2021) |  |
WHO Disease Staging System for HIV Infection and Disease in Adults and Adolescents was first produced in 1990 by the World Health Organization[1] 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.[2]
Following infection with HIV, the rate of clinical disease progression varies enormously between individuals. Many factors such as host susceptibility and immune function,[2][3][4] health care and co-infections,[5][6][7] as well as factors relating to the viral strain [8][9] may affect the rate of clinical disease progression.
Revised World Health Organization (WHO) Clinical Staging of HIV/AIDS For Adults and Adolescents (2005)[edit]
(This is the interim African Region version for persons aged 15 years or more who have had a positive HIV antibody test or other laboratory evidence of HIV infection) (The United Nations 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)
Primary HIV infection[edit]
- Asymptomatic
- Acute retroviral syndrome
Clinical stage 1[edit]
- Asymptomatic
- Persistent generalized lymphadenopathy
Clinical stage 2[edit]
- Moderate and unexplained weight loss (<10% of presumed or measured body weight)
- Recurrent respiratory tract infections (such as sinusitis, bronchitis, otitis media, pharyngitis)
- Herpes zoster
- Recurrent oral ulcerations
- Papular pruritic eruptions
- Angular cheilitis
- Seborrhoeic dermatitis
- Onychomycosis (fungal nail infections)
Clinical stage 3[edit]
Conditions where a presumptive diagnosis can be made on the basis of clinical signs or simple investigations[citation needed]
- 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 candidiasis
- Oral hairy leukoplakia
- 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[citation needed]
- Unexplained anaemia (< 80 g/L), and or neutropenia (<500/μl) and or thrombocytopenia (<50 000/ μl) for more than one month
Clinical stage 4[edit]
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)
- Esophageal 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 (CMV) 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
Original proposal in 1990[edit]
Clinical Stage I[edit]
- Asymptomatic
- Generalised lymphadenopathy
- In some cases symptoms similar to those of cold flue would be manifested.
Performance scale: 1: asymptomatic, normal activity.
Clinical Stage II[edit]
- 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 (i.e. bacterial sinusitis)
And/or performance scale 2: symptomatic, normal activity.
Clinical Stage III[edit]
- 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 tuberculosis
- Severe bacterial infections (i.e. pneumonia, pyomyositis)
And/or performance scale 3: bedridden < 50% of the day during last month.
Clinical Stage IV[edit]
The declaration of AIDS
- HIV wasting syndrome *
- 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 node (ex: retinitis)
- Herpes simplex virus infection, mucocutaneous (>1 month) or visceral
- Progressive multifocal leucoencephalopathy
- Any disseminated endemic mycosis
- Candidiasis of esophagus, trachea, bronchi
- Atypical mycobacteriosis, disseminated or lungs
- Non-typhoid Salmonella septicemia
- Extrapulmonary tuberculosis
- Lymphoma
- Kaposi's sarcoma
- 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.
References[edit]
- ^ WHO; Mahe, C; Mayanja, B; Whitworth, JA (1990). "Interim proposal for a WHO Staging System for HIV infection and Disease" (PDF). Wkly Epidemiol Rec. 65 (29): 221–224. PMID 1974812.
- ^ a b Morgan D, Mahe C, Mayanja B, Whitworth JA (2002). "Progression to symptomatic disease in people infected with HIV-1 in rural Uganda: prospective cohort study". BMJ. 324 (7331): 193–196. doi:10.1136/bmj.324.7331.193. PMC 64788. PMID 11809639.
- ^ Clerici M, Balotta C, Meroni L, Ferrario E, Riva C, Trabattoni D, Ridolfo A, Villa M, Shearer GM, Moroni M, Galli M (1996). "Type 1 cytokine production and low prevalence of viral isolation correlate with long-term nonprogression in HIV infection". AIDS Res Hum Retroviruses. 12 (11): 1053–1061. doi:10.1089/aid.1996.12.1053. PMID 8827221.
- ^ Tang J, Kaslow RA (2003). "The impact of host genetics on HIV infection and disease progression in the era of highly active antiretroviral therapy". AIDS. 17 (Suppl 4): S51–S60. doi:10.1097/00002030-200317004-00006. PMID 15080180.
- ^ Gendelman HE, Phelps W, Feigenbaum L, Ostrove JM, Adachi A, Howley PM, Khoury G, Ginsberg HS, Martin MA (1986). "Trans-activation of the human immunodeficiency virus long terminal repeat sequence by DNA viruses". Proc Natl Acad Sci U S A. 83 (24): 9759–9763. Bibcode:1986PNAS...83.9759G. doi:10.1073/pnas.83.24.9759. PMC 387220. PMID 2432602.
- ^ Bentwich Z, Kalinkovich A, Weisman Z (1995). "Immune activation is a dominant factor in the pathogenesis of African AIDS". Immunol Today. 16 (4): 187–191. doi:10.1016/0167-5699(95)80119-7. PMID 7734046.
- ^ Morgan D, Mahe C, Mayanja B, Okongo JM, Lubega R, Whitworth JA (2002). "HIV-1 infection in rural Africa: is there a difference in median time to AIDS and survival compared with that in industrialized countries?". AIDS. 16 (4): 597–603. doi:10.1097/00002030-200203080-00011. PMID 11873003. S2CID 35450422.
- ^ Quinones-Mateu ME, Mas A, Lain de Lera T, Soriano V, Alcami J, Lederman MM, Domingo E (1998). "LTR and tat variability of HIV-1 isolates from patients with divergent rates of disease progression". Virus Res. 57 (1): 11–20. doi:10.1016/S0168-1702(98)00082-3. PMID 9833881.
- ^ Campbell GR, Pasquier E, Watkins J, Bourgarel-Rey V, Peyrot V, Esquieu D, Barbier P, de Mareuil J, Braguer D, Kaleebu P, Yirrell DL, Loret EP (2004). "The glutamine-rich region of the HIV-1 Tat protein is involved in T-cell apoptosis". J Biol Chem. 279 (46): 48197–48204. doi:10.1074/jbc.M406195200. PMID 15331610.