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)
AsymptomaticAcute retroviral syndromeAsymptomaticPersistent generalized lymphadenopathyModerate and unexplained weight loss (<10% of presumed or measured body weight)Recurrent respiratory tract infections (such as sinusitis, bronchitis, otitis media, pharyngitis)Herpes zosterRecurrent oral ulcerationsPapular pruritic eruptionsAngular cheilitisSeborrhoeic dermatitisOnychomycosis (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 monthUnexplained persistent fever (intermittent or constant for longer than one month)Severe weight loss (>10% of presumed or measured body weight)Oral candidiasisOral hairy leukoplakiaPulmonary tuberculosis (TB) diagnosed in last two yearsSevere presumed bacterial infections (e.g. pneumonia, empyema, meningitis, bacteraemia, pyomyositis, bone or joint infection)Acute necrotizing ulcerative stomatitis, gingivitis or periodontitisConditions 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 monthConditions where a presumptive diagnosis can be made on the basis of clinical signs or simple investigations
HIV wasting syndromePneumocystis pneumoniaRecurrent severe or radiological bacterial pneumoniaChronic herpes simplex infection (orolabial, genital or anorectal of more than one month's duration)Esophageal candidiasisExtrapulmonary tuberculosisKaposi's sarcomaCentral nervous system toxoplasmosisHIV encephalopathyConditions where confirmatory diagnostic testing is necessary
Extrapulmonary cryptococcosis including meningitisDisseminated non-tuberculous mycobacteria infectionProgressive multifocal leukoencephalopathyCandida of trachea, bronchi or lungsCryptosporidiosisIsosporiasisVisceral herpes simplex infectionCytomegalovirus (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 septicaemiaLymphoma (cerebral or B cell non-Hodgkin)Invasive cervical carcinomaVisceral leishmaniasisAsymptomaticGeneralised lymphadenopathyIn some cases symptoms similar to those of cold flue would be manifested.Performance scale: 1: asymptomatic, normal activity.
Weight loss, < 10% of body weightMinor mucocutaneous manifestations (seborrheic dermatitis, prurigo, fungal nail infections, recurrent oral ulcerations, angular cheilitis)Herpes zoster within the last five yearsRecurrent upper respiratory tract infections (i.e. bacterial sinusitis)And/or performance scale 2: symptomatic, normal activity.
Weight loss, > 10% of body weightUnexplained chronic diarrhoea > 1 monthUnexplained prolonged fever (intermittent or constant), > 1 monthOral [candidiasis] ([thrush])Oral hairy leucoplakiaPulmonary tuberculosisSevere 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 pneumoniaToxoplasmosis of the brainCryptosporidiosis with diarrhoea > 1 monthCryptococcosis, extrapulmonaryCytomegalovirus disease of an organ other than liver, spleen or lymph node (ex: retinitis)Herpes simplex virus infection, mucocutaneous (>1 month) or visceralProgressive multifocal leucoencephalopathyAny disseminated endemic mycosisCandidiasis of esophagus, trachea, bronchiAtypical mycobacteriosis, disseminated or lungsNon-typhoid Salmonella septicemiaExtrapulmonary tuberculosisLymphomaKaposi's sarcomaHIV 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.
