HIV/AIDS CLINICAL STAGING FOR ADULTS

HIV /AIDS Stages

World Health Organization Clinical Stage I (Asymptomatic)
No symptoms or only:
Persistent generalized lymphadenopathy( an abnormal enlargement of the lymph nodes)

ARV Therapy 
Start ARV only If CD4<200
Consider ART if CD4 is between 200-350
current trend is test and start treatment if positive


WorldHealth Organization Clinical Stage 2 (Mild disease)
Characterized by:
• Weight loss 5-10%
• Sores or cracks around lips (angular cheilities)
• Itching rash (seborrhoea or prurigo)
• Herpes zoster
• Recurrent upper respiratory infections such as sinusitis or otitis
• Recurrent mouth ulcer

Prophylaxis
• Use Cortrimoxazole prophylaxis
• Septrin

ARV THERAPY 
• Commence only if CD4 <200 OR TLC <1200\mm3
• Consider ARTT start if CD4 is between 200-350
current trend is test and start treatment if positive


World Health Organization Clinical Stage 3 (Advanced disease)
Characterized by:
• Weight loss >10%
• Oral thrust  (or hairy leukoplakia)
• More than 1 month:Diarrhoea and Unexplained fever
• Severe bacterial infections (pneumonia, muscle infection)
• Pulmonary Tuberculosis within the past year
• Acute necrotizing ulcerative gingivitis / periodontitis

Prophylaxis
• Use Cortrimoxazole prophylaxis
• Septrin
• Other prophylactic treatment plans

ARV THERAPY 
• If CD4 is not available,  all in stage 3 is medically eligible
• If CD4 is available start ART if CD4  < 350
• Prepare for adherence
 current trend is test and start treatment if positive


World Health Organization Clinical Stage 4 (Severe disease AIDS)
Characterized by
• HIV wasting syndrome
• Oesophageal thrush
• More than one month of Herpes simplex ulcerations
• Recurrent severe pneumonia
• Pnemocystis pneumonia
• Kaposi’s sarcoma
• Extraplumonary cyptococcus infection  (including meningitis)
• Extraplumonary Tuberculosis
• Taxoplasma brain abscess
• HIV encephalopathy
• CMV retinitis or other CMV Infection
• Visceral leishmaniasis
• Candida infection of trachea, bronchi or lungs
• Cryptosporidiosis or isosporiasis
• Disseminated atypical mycobacteria infection  or fungi infection
• Visceral herpes simplex infection
• Non-typhoid salmonella septicemia
• Invasive cervical cancer
• Lymphoma
• Progressive multifocal leukoencephalopathy (PML)

Prophylaxis
• Cortrimoxazole prophylaxis
• Other prophylactic treatment plans

ARV THERAPY
• All in stage 4 are medically eligible
• Prepare for adherence
current trend is test and start treatment if positive