HIV Staging for Adults and Adolescents (South Africa)

Topics / Medical / HIV and related conditions

Summary This article discusses the WHO Clinical Staging for HIV, its importance and the different components.

Basics

In places were there are sufficient laboratory resources, the CD4+ count is used to assess the patient’s immunological state. While the viral load may be used to assess the rate at which the immune system is destroyed. This information assists the health care practitioner with the management of the patient. For instance, if the CD4 count is < 200, then it is known that the patient will benefit from PJP Prophylaxis.

In areas where there are limited resources this may not be the case, For this reason, the WHO created the HIV Clinical Staging System. It has been proven that there is a good correlation between the patient’s laboratory markers and clinical manifestations. For instance, the guidelines also state that patients who are WHO Stage II, III or IV would also benefit from PJP Prophylaxis.

This staging was created for adolescents/adults older than 15 years old. However, there is a modified one for children younger than 15 years old as well.

It is important to understand that a patient will always remain at the highest stage achieved. The patient stays at this higher stage even if they recover from the condition. For instance, a patient with HIV and pulmonary TB will always remain HIV Stage 3 even after completing their treatment.

Take Note A patient will remain at the highest stage achieved, even if they recover. This is because the staging system is a good predictor of survival in HIV patients.

In a very basic summary:

Stage 1 – Asymptomatic: Asymptomatic or persistent generalized lymphadenopathy (at least two sites [not including the inguinal region] for > 6 months).
Stage 2 – Mild Symptomatic: Patient has minor mild weight loss, recurrent respiratory infections and dermatological manifestations.
Stage 3 – Moderate Symptomatic: Patient has moderate weight loss, chronic diarrhea, pulmonary TB, severe bacterial infections and mucocutaneous lesions (oral candidiasis).
Stage 4 – AIDS: HIV Wasting syndrome, PJP, extrapulmonary TB, Neurological manifestations (HIV encephalopathy, CNS toxoplasmosis), NTMB, malignancies (B-cell, cervical cancer, Kaposi’s sarcoma), and other conditions.

WHO Clinical Staging

Stage 1	Stage 2	Stage 3	Stage 4
Asymptomatic Persistent Generalized Lymphadenopathy	Unexplained moderate weight loss (<10% of presumed or measured body weight) Recurrent respiratory tract infections (sinusitis, otitis media and pharyngitis) Herpes zoster (shingles) Angular stomatitis Recurrent oral ulceration Papular pruritic eruption Seborrhoeic dermatitis Fungal nail infection	Unexplained severe weight loss (>10% of presumed or measured body weight) Unexplained chronic diarrhea for > 1 month Unexplained persistent fever (>37.5C intermittent or constant for > 1 month) Persistent oral candidiasis Oral hairy leukoplakia Pulmonary TB Severe bacterial infections (such as pneumonia, empyema, pyomyositis, bone or joint infection, meningitis, or bacteraemia) Acute necrotizing ulcerative stomatitis, gingivitis, or periodontitis Unexplained anemia (< 8g/dL), neutropenia (< 0.5x10^9/L) and/or chornic thrombocytopenia (<50x10^9/L)	HIV wasting syndrome Extrapulmonary tuberculosis Pneumocystis pneumonia Recurrent severe bacterila pneumonia Chronic herpes simplex infection > 1month HIV wasting syndrome Oesophageal candidiasis, trachea, bronchi or lungs Kaposi's sarcoma Cytomegalovirus infection (retinitis or other organs) Central nervous system toxoplasmosis HIV encephalopathy Extrapulmonary cryptococcosis including meningitis Disseminated non-tuberculous mycobacterial infection Progressive Multifocal leukoencephalopathy Chronic cryptosporidiosis Chronic isosporiasis Disseminated mycosis Recurrent septicemia Lymphoma (cerebral or B-cell non-hodgkin) Invasive cervical carcinoma Atypical disseminated leishmaniasis Symptomatic HIV-associated nephropathy or symptomatic HIV-associated cardiomyopathy