Transcript HIV Clinical Staging by WHO

HIV Clinical Staging
HAIVN
Harvard Medical School AIDS
Initiative in Vietnam
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Learning Objectives
By the end of this session, participants
should be able to:
 Determine the clinical stage of an
HIV patient
 Explain when to evaluate the clinical
stage of the patient
 Explain how to apply clinical staging
before and after ARV treatment
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WHO Clinical Staging System
WHO Clinical Stage can be used to:
 Estimate degree of damage done to a
patient’s immune system
 Follow progression of HIV disease
 Determine when to start:
• prophylactic treatment with cotrimoxazole
• antiretroviral therapy (ART)

Follow patient’s response to ART
WHO Clinical Stage should be evaluated at
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every clinic visit
Application of Clinical Staging in
Relation to ARV Treatment
Before ARV:
 Identify highest
clinical stage
patient has
reached
 Reason: Determine
eligibility for ARV
treatment
After Starting ARV:
 Re-evaluate
current clinical
status of patient
 Reason: Assess the
improvement of
clinical status and
the response to
ARV treatment
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WHO Clinical Stages
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Stage 1: Asymptomatic
Most typical/common syndromes:
 Asymptomatic
 Persistent generalized
lymphadenophathy
Performance Scale: Normal activity
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Stage 2: Mildly Symptomatic
Most typical/common syndromes:
 Moderate unexplained weight loss (<
10% of body weight)
 Recurrent respiratory infections
 Zona (Herpes zoster)
 Papular pruritic eruption (PPE)
Performance Scale: symptomatic
but normal activity
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Stage 3: Progressively Symptomatic
Most typical/common syndromes:
 Unexplained:
• severe weight loss (> 10% of body weight)
• chronic diarrhea for > 1 month
• persistent fever for > 1 month
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Recurrent oral candidiasis
Pulmonary tuberculosis
Severe bacterial infections
Unexplained anemia, neutropenia, or
thrombocytopenia
Performance Scale: symptomatic,
in bed < 50% of the time
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Stage 4: Severely Symptomatic
Most typical/common syndromes:
 Extrapulmonary tuberculosis
 Pneumocystis jiroveci Pneumonia (PCP)
 Esophageal candidiasis
 CNS Toxoplasmosis
 Cryptococcal meningitis
 Penicilliosis
 CMV retinitis
Performance Scale: bedridden > 50% of the
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time
What is her Clinical Stage?
Nguyet was treated for lymph node
TB from January to September
2009. Currently she has no fever or
other symptoms of an OI. She lost
12 kg before TB treatment and
gained 6 kg after treatment. She is
not yet on ARV.
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What is her Clinical Stage?
6 months after starting ARV
Nguyet has gained another 3
kg. She feels well but now has
herpes zoster (zona) on her
left side.
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Immunological Staging
Immune status is evaluated by CD4 cell count
Severity
Normal or unremarkable
deficiency
CD4 mm3
> 500
Mild deficiency
350 - 499
Progressive deficiency
200 - 349
Severe deficiency
< 200
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Criteria for Diagnosis of Advanced HIV
Infection (Including AIDS)
Advanced HIV
Infection:
 Having any clinical
stage 3 or 4
condition
(presumptive or
definitive diagnosis)
and/or
 CD4 cell count <
350 cells/mm3
AIDS:
 Having any clinical
stage 4 condition
(presumptive or
definitive
diagnosis)
or
 CD4 cell count <
200 cells/mm3
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Key Points


WHO clinical staging classifies patient
into 4 categories based on clinical
symptoms
Perform clinical staging at each visit to:
• determine eligibility for ART
• assess patient’s response to ART

CD4 count, clinical staging are used to:
• evaluate status of patient’s immune system
• decide when to start OI prophylaxis and
ART
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Thank you!
Questions?
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