WHO Staging System HIV Infection & Disease

 

Clinical stages:

(1) asymptomatic or persistent generalized lymphadenopathy

(2) early or mild disease

(3) intermediate or moderate disease

(4) late or severe disease, essentially equivalent to AIDS

 

Clinical Stage 1 - one or more of the following:

(1) asymptomatic, performance scale 1

(2) persistent generalized lymphadenopathy (PGL), maintaining normal activities

 

Clinical Stage 2 - one or more of the following:

(1) weight loss < 10% of usual body weight

(2) minor mucocutaneous manifestations (seborrheic dermatitis, prurigo, fungal nail infections, recurrent oral ulcerations, angular cheilitis)

(3) herpes zoster within the last 5 years

(4) recurrent upper respiratory tract infections such as sinusitis

(5) performance scale 2

 

Clinical Stage 3 - one or more of the following:

(1) weight loss > 10% of body weight

(2) unexplained chronic diarrhea for > 1 month

(3) unexplained prolonged fever (intermittent or constant), > 1 month

(4) oral candidiasis (thrush)

(5) oral hairy leukoplakia

(6) pulmonary tuberculosis within the past year

(7) severe bacterial infection such as pneumonia or pyomyositis

(8) performance scale 3

 

Clinical Stage 4 - one or more of the following:

(1) HIV wasting syndrome as defined by the CDC: weight loss > 10% of body weight plus either unexplained chronic diarrhea > 1 month or chronic weakness with unexplained, prolonged fever > 1 month

(2) Pneumocystis carinii pneumonia

(3) toxoplasmosis of the brain

(4) cryptosporidiosis with diarrhea > 1 month

(5) cryptococcosis, extrapulmonary

(6) cytomegalovirus disease of an organ other than liver, spleen or lymph node

(7) herpes simplex virus infection, mucocutaneous > 1 month, or visceral of any duration

(8) progressive multifocal leukoencephalopathy

(9) any disseminated endemic mycosis such as histoplasmosis or coccidioidomycosis

(10) candidiasis of the esophagus, trachea, bronchi or lungs

(11) atypical mycobacteriosis, disseminated

(12) non-typhoid Salmonella septicemia

(13) extrapulmonary tuberculosis

(14) malignant lymphoma

(15) Kaposi’s sarcoma

(16) HIV encephalitis as defined by the CDC: 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 that can explain the findings

(17) performance scale 4

 

Performance Scale	Criteria
1	asymptomatic with normal activity
2	symptomatic but normal activity
3	bed-ridden < 50% of day during the last month
4	bed-ridden >= 50% of day during the last month

 

Laboratory Data

 

Lymphocytes per µL		CD4 lymphocyte count	Laboratory Stage
> 2,000	or	> 500	A
1,000 - 2,000	or	200 - 500	B
< 1,000	or	< 200	C

 

WHO Stages Based on Clinical and Laboratory Findings

 

Laboratory	Clinical Stage 1 (asympto-matic or PGL)	Clinical Stage 2 (early)	Clinical Stage3 (intermediate)	Clinical Stage 4 (late)
A	1A	2A	3A	4A
B	1B	2B	3B	4B
C	1C	2C	3C	4C
unknown	1	2	3	4

 

Differences from 1993 CDC Classification

 

Most of the clinical conditions in the WHO schema (published 1990) are based on the CDC 1986 classification. The following from the CDC 1993 revision are not included:

(1) cervical dysplasia, carcinoma in situ, and carcinoma

(2) chronic vulvovaginal resistant to therapy

(3) chronic Isospora infection

(4) pelvic inflammatory disease (PID)

(5) CMV retinitis

(6) Listeriosis

(7) bacillary angiomatosis

(8) ITP

(9) peripheral neuropathy

(10) acute HIV infection (added to spreadsheet implementation)

 

The following are different:

(1) herpes zoster infection (less restrictive)

(2) laboratory criteria (different elements specified)

 

Additions to CDC definitions:

(1) use of a performance scale

 

Limitations:

(1) Some indicators (fungal nail infections, recurrent sinusitis) occur with frequency in the general population without recourse to immunosuppression. These should be invoked only if of new onset or if excessive in some way.

(2) Prognosis for patients in groups 1,2 and 3 are similar, whereas several prognostic subclasses are compressed into group 4.

 

Modification of Montaner et al (1992)

 

Original CDC Designation	Stage of Montaner et al
1A	I
2A	I
3A	II
4A	IV
1B	II
2B	II
3B	III
4B	IV
1C	III
2C	III
3C	IV
4C	IV

 

 

Stage	Estimated Median Survival in Years
I	11.3
II	9.7
III	4.4
IV	2.6

(from Table 5, page 723, Montaner, 1992)

 

where:

• survival times in developed countries have improved since 1992 with the use of newer therapeutic agents