HIV AIDS classification: Difference between revisions

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* Stage IV: includes [[toxoplasmosis]] of the [[brain]], [[candidiasis]] of the [[esophagus]], [[Vertebrate trachea|trachea]], [[bronchi]] or [[lung]]s and [[Kaposi's sarcoma]]; these diseases are indicators of AIDS.
* Stage IV: includes [[toxoplasmosis]] of the [[brain]], [[candidiasis]] of the [[esophagus]], [[Vertebrate trachea|trachea]], [[bronchi]] or [[lung]]s and [[Kaposi's sarcoma]]; these diseases are indicators of AIDS.


===WHO staging system for HIV [[infection]] and disease in adults<ref name=CDC>{{cite web | title = CDC Global AIDS module| url = http://www.cdc.gov/globalaids/Resources/pmtct-care/docs/PM/Module_1PM.pdf }}</ref>===
===WHO staging system for HIV [[infection]] and disease in adults and adolescents<ref name=CDC>{{cite web | title = CDC Global AIDS module| url = http://www.cdc.gov/globalaids/Resources/pmtct-care/docs/PM/Module_1PM.pdf }}</ref>===


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Revision as of 15:29, 8 October 2014

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Ammu Susheela, M.D. [2]

Overview

Since June 5, 1981, many definitions have been developed for epidemiological surveillance such as the Bangui definition and the 1994 expanded World Health Organization AIDS case definition. However, clinical staging of patients was not an intended use for these systems as they are neither sensitive, nor specific. In developing countries, the World Health Organization staging system for HIV infection and disease, using clinical and laboratory data, is used and in developed countries, the Centers for Disease Control (CDC) Classification System is used.

Classification

WHO Disease Staging System for HIV Infection and Disease

In 1990, the World Health Organization (WHO) grouped these infections and conditions together by introducing a staging system for patients infected with HIV-1.[1] An update took place in September 2005. Most of these conditions are opportunistic infections that are easily treatable in healthy people.

WHO staging system for HIV infection and disease in adults and adolescents[2]

Clinical stage Features
Clinical stage 1
Clinical stage 2
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 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

  • 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 (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

WHO staging system for HIV infection and disease in children

Clinical stage Features
Clinical stage 1
Clinical stage 2
Clinical stage 3

CDC Classification System for HIV Infection

In the beginning, the Centers for Disease Control and Prevention (CDC) did not have an official name for the disease, often referring to it by way of the diseases that were associated with it, for example, lymphadenopathy, the disease after which the discoverers of HIV originally named the virus.[3][4] They also used Kaposi's Sarcoma and Opportunistic Infections, the name by which a task force had been set up in 1981.[5] In the general press, the term GRID, which stood for Gay-related immune deficiency, had been coined.[6] However, after determining that AIDS was not isolated to the homosexual community,[5] the term GRID became misleading and AIDS was introduced at a meeting in July 1982.[7] By September 1982 the CDC started using the name AIDS, and properly defined the illness.[8] In 1993, the CDC expanded their definition of AIDS to include all HIV positive people with a CD4+ T cell count below 200 per µL of blood or 14% of all lymphocytes.[9] The majority of new AIDS cases in developed countries use either this definition or the pre-1993 CDC definition. The AIDS diagnosis still stands even if, after treatment, the CD4+ T cell count rises to above 200 per µL of blood or other AIDS-defining illnesses are cured.

Comparison Between AIDS and HIV

The following tables compares AIDS and HIV:

Parameter AIDS HIV
Definition Most advance stage of HIV disease. A CD4 count of fewer than 200 cells/mm3 is one of the qualifications for a diagnosis of AIDS. It occurs when weakened immune system of the patient, due to Human Immunodeficiency Virus , developes one or more opportunistic infections. HIV is a virus, harming the body’s immune system by attacking helper T cells or CD4 cells.
Spread of infection Only patients with HIV can develop AIDS HIV can be spread through various ways; most notable being sexual intercourse, the exchange of certain body fluids (blood, pre-ejaculate, semen, vaginal secretions, and breast milk).
Treatment ART has only proved to be palliative rather being curative ART can slow the progression from HIV to AIDS, and increase survival. Some researches have claimed to cure the disease [10], while others have a different opinion.[11]

Summary

HIV virus can cause AIDS. However not everyone who is infected with HIV develops AIDS. HIV infected patients can live for years without developing AIDS symptoms.

References

  1. World Health Organization (1990). "Interim proposal for a WHO staging system for HIV infection and disease". WHO Wkly Epidem. Rec. 65 (29): 221&ndash, 228. PMID 1974812.
  2. "CDC Global AIDS module" (PDF).
  3. Centers for Disease Control (CDC) (1982). "Persistent, generalized lymphadenopathy among homosexual males". MMWR Morb Mortal Wkly Rep. 31 (19): 249&ndash, 251. PMID 6808340.
  4. Barré-Sinoussi F, Chermann JC, Rey F; et al. (1983). "Isolation of a T-lymphotropic retrovirus from a patient at risk for acquired immune deficiency syndrome (AIDS)". Science. 220 (4599): 868–871. doi:10.1126/science.6189183. PMID 6189183.
  5. 5.0 5.1 Centers for Disease Control (CDC) (1982). "Opportunistic infections and Kaposi's sarcoma among Haitians in the United States". MMWR Morb Mortal Wkly Rep. 31 (26): 353&ndash, 354, 360&ndash, 361. PMID 6811853.
  6. Altman LK (1982-05-11). "New homosexual disorder worries officials". The New York Times.
  7. Kher U (1982-07-27). "A Name for the Plague". Time. Retrieved 2008-03-10.
  8. Centers for Disease Control (CDC) (1982). "Update on acquired immune deficiency syndrome (AIDS)—United States". MMWR Morb Mortal Wkly Rep. 31 (37): 507&ndash, 508, 513&ndash, 514. PMID 6815471.
  9. "1993 Revised Classification System for HIV Infection and Expanded Surveillance Case Definition for AIDS Among Adolescents and Adults". CDC. 1992. Retrieved 2006-02-09.
  10. Hütter G, Nowak D, Mossner M, Ganepola S, Müssig A, Allers K, Schneider T, Hofmann J, Kücherer C, Blau O, Blau IW, Hofmann WK, Thiel E (2009). "Long-term control of HIV by CCR5 Delta32/Delta32 stem-cell transplantation". N. Engl. J. Med. 360 (7): 692–8. doi:10.1056/NEJMoa0802905. PMID 19213682. Retrieved 2012-03-02. Unknown parameter |month= ignored (help)
  11. Levy JA (2009). "Not an HIV cure, but encouraging new directions". N. Engl. J. Med. 360 (7): 724–5. doi:10.1056/NEJMe0810248. PMID 19213687. Retrieved 2012-03-02. Unknown parameter |month= ignored (help)

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