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At present the WHO disease staging system for HIV Infection and Disease in Children is as follows:
Clinical Stage 1:
Asymptomatic
Persistent generalized lymphadenopathy
Clinical Stage 2:
Hepatosplenomegaly
Papular pruritic eruptions
Seborrhoeic dermatitis
Extensive human papilloma virus infection
Extensive molluscum contagiosum
Fungal nail infections
Recurrent oral ulcerations
Linear gingival erythema (LGE)
Angular cheilitis
Parotid enlargement
Herpes zoster
Recurrent or chronic RTIs (otitis media, otorrhoea, sinusitis)
Clinical Stage 3:
- Conditions where a presumptive diagnosis can be made on the basis of clinical signs or simple investigations:
Moderate unexplained malnutrition not adequately responding to standard therapy
Unexplained persistent diarrhoea (14 days or more )
Unexplained persistent fever (intermittent or constant, for longer than one month)
Oral candidiasis (outside neonatal period )
Oral hairy leukoplakia
Acute necrotizing ulcerative gingivitis/periodontitis
Pulmonary TB
Severe recurrent presumed bacterial pneumonia
- Conditions where confirmatory diagnostic testing is necessary:
Chronic HIV-associated lung disease including brochiectasis
Lymphoid interstitial pneumonitis (LIP)
Unexplained anaemia (<80g/l), and or neutropenia (<1000/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
Unexplained severe wasting or severe malnutrition not adequately responding to standard therapy:
Pneumocystis pneumonia
Recurrent severe presumed bacterial infections (e.g. empyema, pyomyositis, bone or joint infection, meningitis, but excluding pneumonia)
Chronic herpes simplex infection; (orolabial or cutaneous of more than one month’s duration)
Extrapulmonary Tuberculosis
Kaposi’s sarcoma
Oesophageal candidiasis
Central nervous system toxoplasmosis (outside the neonatal period)
HIV encephalopathy
- Conditions where confirmatory diagnostic testing is necessary:
CMV infection (CMV retinitis or infection of organs other than liver, spleen or lymph nodes; onset at age one month or more)
Extrapulmonary cryptococcosis including meningitis
Any disseminated endemic mycosis (e.g. extrapulmonary histoplasmosis, coccidiomycosis, penicilliosis)
Cryptosporidiosis
Isosporiasis
Disseminated non-tuberculous mycobacteria infection
Candida of trachea, bronchi or lungs
Visceral herpes simplex infection
Acquired HIV associated rectal fistula
Cerebral or B cell non-Hodgkin lymphoma
Progressive multifocal leukoencephalopathy (PML)
HIV-associated cardiomyopathy or HIV-associated nephropathy
The presumptive diagnosis above is designed for use where access to confirmatory diagnostic testing for HIV infection by means of virological testing (usually nucleic acid testing, NAT) or P24 antigen testing for infants and children aged under 18 months is not readily available.
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