Table 23WHO paediatric clinical staging system for HIV infection

For use in children aged < 13 years with confirmed laboratory evidence of HIV infection (HIV antibodies for children > 18 months, virological testing for those aged < 18 months)
STAGE 1
–

Asymptomatic

–

Persistent generalized lymphadenopathy

STAGE 2
–

Hepatosplenomegaly

–

Papular pruritic eruptions

–

Seborrhoeic dermatitis

–

Fungal nail infections

–

Angular cheilitis

–

Linear gingival erythema

–

Extensive human papillomavirus infection or molluscum infection (> 5% body area)

–

Recurrent oral ulcerations (two or more episodes in 6 months)

–

Parotid enlargement

–

Herpes zoster

–

Recurrent or chronic upper respiratory tract infection (otitis media, otorrhoea, sinusitis; two or more episodes in any 6-month period)

STAGE 3
–

Unexplained moderate malnutrition that does not respond to standard therapy

–

Unexplained persistent diarrhoea (> 14 days)

–

Unexplained persistent fever (intermittent or constant, for > 1 month)

–

Oral candidiasis (outside neonatal period)

–

Oral hairy leukoplakia

–

Pulmonary TBa

–

Severe recurrent presumed bacterial pneumonia (two or more episodes in 6 months)

–

Acute necrotizing ulcerative gingivitis or periodontitis

–

Lymphoid interstitial pneumonia

–

Unexplained anaemia (< 8 g/dl), neutropenia (< 500/mm3) or thrombocytopenia (< 30 000/mm3) for > 1 month

–

HIV-related cardiomyopathy

–

HIV-related nephropathy

STAGE 4
–

Unexplained severe wasting or severe malnutrition that does not respond to standard therapy

–

PCP

–

Recurrent severe presumed bacterial infections (two or more episodes within 1 year, e.g. empyema, pyomyositis, bone or joint infection, meningitis, but excluding pneumonia)

–

Chronic orolabial or cutaneous herpes simplex infection (lasting > 1 month)

–

Disseminated or extrapulmonary TB

–

Kaposi sarcoma

–

Oesophageal candidiasis

–

Symptomatic HIV seropositive infant < 18 months with two or more of the following: oral thrush, severe pneumonia, failure to thrive, severe sepsisb

–

Cytomegalovirus retinitis

–

Central nervous system toxoplasmosis

–

Any disseminated endemic mycosis, including cryptococcal meningitis (e.g. extrapulmonary cryptococcosis, histoplasmosis, coccidiomycosis, penicilliosis)

–

Cryptosporidiosis or isosporiasis (with diarrhoea lasting > 1 month)

–

Cytomegalovirus infection (onset at age > 1 month in an organ other than liver, spleen or lymph nodes)

–

Disseminated mycobacterial disease other than TB

–

Candida of trachea, bronchi or lungs

–

Acquired HIV-related rectovesical fistula

–

Cerebral or B cell non-Hodgkin lymphoma

–

Progressive multifocal leukoencephalopathy

–

HIV encephalopathy

a

TB may occur at any CD4 count; the percentage CD4 should be considered when available.

b

Presumptive diagnosis of stage 4 disease in seropositive children < 18 months requires confirmation with HIV virological tests or an HIV antibody test after 18 months of age.

From: 8, Children with HIV/AIDS

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Pocket Book of Hospital Care for Children: Guidelines for the Management of Common Childhood Illnesses. 2nd edition.
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