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.
Revised World Health Organization (WHO) Clinical Staging of HIV/AIDS For Adults and Adolescents (2005)
(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)
Asymptomatic
Acute retroviral syndrome
Asymptomatic
Persistent generalized lymphadenopathy
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)
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
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
Asymptomatic
Generalised lymphadenopathy
In some cases symptoms similar to those of cold flue would be manifested.
Performance scale: 1: asymptomatic, normal activity.
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.
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.
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.
