WHO Disease Staging System for HIV Infection and Disease in Adults and Adolescents

From Wikipedia, the free encyclopedia
Jump to navigation Jump to search

WHO Disease Staging System for HIV Infection and Disease in Adults and Adolescents was first produced in 1990 by the World Health Organization [1] 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.[2]

Following infection with HIV, the rate of clinical disease progression varies enormously between individuals. Many factors such as host susceptibility and immune function,[2][3][4] health care and co-infections,[5][6][7] as well as factors relating to the viral strain [8][9] may affect the rate of clinical disease progression.

Revised World Health Organization (WHO) Clinical Staging of HIV/AIDS For Adults and Adolescents (2005)[edit]

(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)

Primary HIV infection[edit]

Clinical stage 1[edit]

Clinical stage 2[edit]

Clinical stage 3[edit]

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[edit]

Conditions where a presumptive diagnosis can be made on the basis of clinical signs or simple investigations

Conditions where confirmatory diagnostic testing is necessary

Original proposal in 1990[edit]

Clinical Stage I[edit]

  • Asymptomatic
  • Generalised lymphadenopathy
  • In some cases symptoms similar to those of cold flue would be manifested.

Performance scale: 1: asymptomatic, normal activity.

Clinical Stage II[edit]

  • 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.

Clinical Stage III[edit]

And/or performance scale 3: bedridden < 50% of the day during last month.

Clinical Stage IV[edit]

The declaration of AIDS

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.


  1. ^ WHO; Mahe, C; Mayanja, B; Whitworth, JA (1990). "Interim proposal for a WHO Staging System for HIV infection and Disease" (PDF). Wkly Epidemiol Rec. 65 (29): 221–224. PMID 1974812.
  2. ^ a b Morgan D, Mahe C, Mayanja B, Whitworth JA (2002). "Progression to symptomatic disease in people infected with HIV-1 in rural Uganda: prospective cohort study". BMJ. 324 (7331): 193–196. doi:10.1136/bmj.324.7331.193. PMC 64788. PMID 11809639.
  3. ^ Clerici M, Balotta C, Meroni L, Ferrario E, Riva C, Trabattoni D, Ridolfo A, Villa M, Shearer GM, Moroni M, Galli M (1996). "Type 1 cytokine production and low prevalence of viral isolation correlate with long-term nonprogression in HIV infection". AIDS Res Hum Retroviruses. 12 (11): 1053–1061. doi:10.1089/aid.1996.12.1053. PMID 8827221.
  4. ^ Tang J, Kaslow RA (2003). "The impact of host genetics on HIV infection and disease progression in the era of highly active antiretroviral therapy". AIDS. 17 (Suppl 4): S51–S60. doi:10.1097/00002030-200317004-00006. PMID 15080180.
  5. ^ Gendelman HE, Phelps W, Feigenbaum L, Ostrove JM, Adachi A, Howley PM, Khoury G, Ginsberg HS, Martin MA (1986). "Trans-activation of the human immunodeficiency virus long terminal repeat sequence by DNA viruses". Proc Natl Acad Sci U S A. 83 (24): 9759–9763. Bibcode:1986PNAS...83.9759G. doi:10.1073/pnas.83.24.9759. PMC 387220. PMID 2432602.
  6. ^ Bentwich Z, Kalinkovich A, Weisman Z (1995). "Immune activation is a dominant factor in the pathogenesis of African AIDS". Immunol Today. 16 (4): 187–191. doi:10.1016/0167-5699(95)80119-7. PMID 7734046.
  7. ^ Morgan D, Mahe C, Mayanja B, Okongo JM, Lubega R, Whitworth JA (2002). "HIV-1 infection in rural Africa: is there a difference in median time to AIDS and survival compared with that in industrialized countries?". AIDS. 16 (4): 597–603. doi:10.1097/00002030-200203080-00011. PMID 11873003.
  8. ^ Quinones-Mateu ME, Mas A, Lain de Lera T, Soriano V, Alcami J, Lederman MM, Domingo E (1998). "LTR and tat variability of HIV-1 isolates from patients with divergent rates of disease progression". Virus Res. 57 (1): 11–20. doi:10.1016/S0168-1702(98)00082-3. PMID 9833881.
  9. ^ Campbell GR, Pasquier E, Watkins J, Bourgarel-Rey V, Peyrot V, Esquieu D, Barbier P, de Mareuil J, Braguer D, Kaleebu P, Yirrell DL, Loret EP (2004). "The glutamine-rich region of the HIV-1 Tat protein is involved in T-cell apoptosis". J Biol Chem. 279 (46): 48197–48204. doi:10.1074/jbc.M406195200. PMID 15331610.