CLINICAL FEATURES OF HIV

The WHO Clinical Staging of HIV for adults and children in the tables below shows the typical clinical features of HIV infection. The staging is based on demonstration of one or more opportunistic infections or key findings and correlates
with disease progression and prognosis of survival.

WHO Staging for HIV Infection and Disease in Adults and Adolescents

Clinical Stage I: Asymptomatic

  1. Asymptomatic
  2. Persistent generalised lymphadenopathy

Performance Scale 1: asymptomatic, normal activity

Clinical Stage II: Mild

  1. Moderate weight loss (< 10% of presumed or measured body weight)
  2. Minor mucocutaneous manifestations (seborrheic dermatitis, prurigo, fungal nail infections, recurrent oral ulcerations, angular stomatitis/cheilitis)
  3. Herpes zoster within the last 5 years
  4. Recurrent upper respiratory tract infections (e.g. bacterial sinusitis, tonsillitis, otitis media, and pharyngitis)

And/or performance scale 2: symptomatic but normal
activity

Clinical Stage III: Advanced

  1. Severe weight loss (more than 10% of presumed or measured body weight)
  2. Unexplained chronic diarrhoea for longer than 1 month
  3. Unexplained persistent fever, intermittent or constant, for longer than 1 month
  4. Persistent oral candidiasis
  5. Oral hairy leukoplakia
  6. Pulmonary tuberculosis
  7. Severe bacterial infections (such as pneumonia, pyomyositis, empyema, bacteraemia or meningitis)
  8. Acute necrotizing ulcerative stomatitis, gingivitis or periodontitis
  9. Unexplained anaemia (< 8 g/dl), neutropenia (< 0.5×109 per litre), or chronic thrombocytopenia (< 50× 109 per litre)

And/or performance scale 3: Bed ridden for less than 50% of the day during the last month

Clinical Stage IV: Severe

  1. HIV wasting syndrome: weight loss of more than 10% and unexplained chronic diarrhoea for more than 1 month, chronic weakness, or unexplained prolonged fever for more than 1 month
  2. Pneumocystis jirovecii pneumonia (PCP)
  3. Recurrent severe bacterial pneumonia
  4. Toxoplasmosis of the brain
  5. Cryptosporidiosis with diarrhoea for longer than 1 month
  6. Chronic isosporiasis
  7. Extrapulmonary cryptococcosis including meningitis
  8. Cytomegalovirus infection (retinitis or other organs)
  9. Herpes simplex virus (HSV) infection (orolabial, genital or anorectal of >1 month’s duration or visceral at any site)
  10. Progressive multifocal leukoencephalopathy (PML)
  11. Any disseminated endemic mycosis such as histoplasmosis, coccidioidomycosis
  12. Candidiasis of the oesophagus, trachea, bronchi, or lungs
  13. Disseminated non-tuberculous mycobacterial infection
  14. Recurrent septicaemia (including non-typhoid salmonella)
  15. Extrapulmonary tuberculosis
  16. Lymphoma (cerebral or B-cell non-Hodgkin)
  17. Invasive cancer of the cervix
  18. Kaposi sarcoma
  19. HIV encephalopathy – disabling cognitive and/or motor dysfunction interfering with activities of daily living, progressing slowly over weeks or months, in the absence of concurrent illness or condition other than
    HIV infection that could account for the findings
  20. Atypical disseminated leishmaniasis
  21. Symptomatic HIV-associated nephropathy or symptomatic HIV associated cardiomyopathy

And/or performance scale 4: Bed-ridden for more than
50% of the day during the last month

WHO Clinical Staging of HIV for Infants and Children with
HIV Infection

Clinical Stage I: Asymptomatic

  1. Asymptomatic
  2. Persistent generalised lymphadenopathy
Clinical Stage II: Mild

  1. Unexplained persistent hepatosplenomegaly
  2. Papular pruritic eruptions
  3. Extensive wart virus infection
  4. Extensive molluscum contagiosum
  5. Recurrent oral ulceration
  6. Unexplained persistent parotid enlargement
  7. Lineal gingival erythema
  8. Herpes zoster
  9. Recurrent or chronic upper respiratory tract infections
    (otitis media, otorrhoea, sinusitis, tonsillitis)
  10. Fungal nail infections
Clinical Stage III: Advanced

  1. Unexplained moderate malnutrition not adequately responding to standard therapy
  2. Unexplained persistent diarrhoea (14 days or more)
  3. Unexplained persistent fever (above 37.5°C, intermittent or constant for longer than one month)
  4. Persistent oral candidiasis (after first 6 weeks of life)
  5. Oral hairy leukoplakia
  6. Acute necrotizing ulcerative gingivitis/periodontitis
  7. Lymph node TB
  8. Pulmonary TB
  9. Severe recurrent bacterial pneumonia
  10. Symptomatic lymphoid interstitial pneumonitis
  11. Chronic HIV-associated lung disease including bronchiectasis
  12. Unexplained anaemia (< 8 g/dL), neutropenia (< 0.5 x
    109/L) or chronic thrombocytopenia (< 50 x 109/ L)
Clinical Stage IV: Severe

  1. Unexplained severe wasting, stunting or severe malnutrition not responding to standard therapy
  2. Pneumocystis jirovecii pneumonia (PCP)
  3. Recurrent severe bacterial infections (e.g. empyema, pyomyositis, bone or joint infection, meningitis but excluding pneumonia)
  4. Chronic herpes simplex infection (orolabial or cutaneous of more than one month’s duration, or visceral at any site)
  5. Extrapulmonary TB
  6. Kaposi sarcoma
  7. Oesophageal candidiasis (or candidiasis of trachea, bronchi or lungs)
  8. Central nervous system toxoplasmosis (after the neonatal period)
  9. HIV encephalopathy
  10. Cytomegalovirus (CMV) infection, retinitis, or of other
    organs with onset at age > 1 month
  11. Extrapulmonary cryptococcosis (including meningitis)
  12. Disseminated endemic mycosis (extrapulmonary histoplasmosis, coccidiomycosis)
  13. Chronic cryptosporidiosis (with diarrhoea )
  14. Chronic isosporiasis
  15. Disseminated non-tuberculous mycobacterial infection
  16. Cerebral or B cell non-Hodgkin lymphoma
  17. Progressive multifocal leukoencephalopathy
  18. HIV-associated cardiomyopathy or nephropathy

Differential diagnosis

  • TB
  • Untreated diabetes mellitus
  • Malnutrition
  • Cancer
  • Other chronic diseases