Classification of HIV in children

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Classification of HIV in children

• Mark Cotton
• Childrens Infectious Disease Clinical Research
  Unit (KID-CRU)
• Faculty of Health Sciences
• Stellenbosch University
• Tygerberg Childrens
• Hospital

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whqlibdoc.who.int/hq/2005/WHO_HIV_2005.02.pdf
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Stage 1
Asymptomatic Persistent generalised
lymphadenopathy (PGL)
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Stage 2

• Hepato/splenomegaly
• Papular pruritic eruptions
• Seborrhoeic dermatitis
• Fungal nail infections
• Angular chelitis
• Lineal gingival erythema (LGE)
• Extensive Human papilloma virus infection
• Molluscum infection (gt5 body area)

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Stage 2 (continued)

• Recurrent oral ulcerations 2 in 6m
• Parotid enlargement
• Herpes zoster
• Recurrent or chronic upper respiratory tract
  infections (otitis media or otorrhoea, sinusitis
  - 2 in 6m)

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Stage 3Presumptive clinical diagnosis

• Unexplained mild-moderate malnutrition not
  responding to standard therapy (-2 SD)
• Unexplained persistent diarrhoea 14 days
• Unexplained persistent fever (intermittent or
  constant gt1month)
• Oral candidiasis (outside neonatal period)
• Oral hairy leukoplakia
• Recurrent presumed bacterial pneumonia
• Acute necrotizing ulcerative gingivitis /
  periodontitis
• Pulmonary Tuberculosis

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Stage 3Where diagnostic tests necessary

• Unexplained Anaemia ( not responsive to
  appropriate haematinics) (lt8mg/dl), neutropenia
  (lt500/mm3) or thrombocytopenia (lt50,000/mm3) gt 1m
• Symptomatic Lymphoid Interstitial Pneumonitis
  (cor pulmonale / hypoxia)
• Chronic HIV-related lung disease including
  bronchiectasis

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Stage 4Conditions where clinical diagnosis
acceptable

• Severe malnutrition not responding well to
  nutritional rehabilitation and treatment of
  underlying disease
• Pneumocystis pneumonia
• Recurrent severe presumed bacterial infections
  (2 episodes in 1y e.g. empyema, pyomyositis,
  bone or joint infection, meningitis, excluding
  pneumonia )
• Chronic orolabial or cutaneous Herpes simplex
  infection (gt1 m duration)

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Stage 4 (continued)

• Kaposi's sarcoma
• Oesophageal candidiasis
• HIV encephalopathy
• CNS Toxoplasmosis outside neonatal period
• Extrapulmonary TB
• Acquired rectal fistula

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Stage 4Laboratory confirmation needed

• CMV infection (onset gt1 m of age organ other than
  liver, spleen, or lymph nodes)
• Extrapulmonary cryptococosis including meningitis
• Any disseminated endemic mycosis
• (e.g. extra-pulmonary Histoplasmosis,
  Coccidiomycosis, Penicilliosis)
• Cryptosporidiosis or Isosporiasis
• (with diarrhoea gt 1 m)

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Stage 4

• Disseminated mycobacterial disease other than
  tuberculous
• Candida of tracheal, bronchi or lungs
• Visceral HSV
• Cerebral or B cell non-Hodgkin's lymphoma
• Progressive multifocal leukoencephalopathy (PML)
• HIV-associated nephropathy or cardiomyopathy

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Presumptive stage 4Infant lt18m

• HIV antibody ve
• symptomatic disease
• 2 or more of
• any failure to thrive
• oral thrush
• severe pneumonia
• sepsis
• Supporting evidence HIV
• Wasting disease in mother
• Recent maternal death