WHO clinical staging of HIV/AIDS for children with confirmed HIV infection

Neelam Maurya

8 years ago

WHO clinical staging of HIV/AIDS for children with confirmed HIV infection

Clinical stage 1

Clinical stage 2

Clinical stage 3

Unexplained moderate malnutrition or wasting not adequately responding to standard therapy Unexplained persistent diarrhoea (14 days or more)
Unexplained persistent fever (above 37.5°C intermittent or constant,for longer than one month)
Persistent oral candidiasis (after first 6-8 weeks of life)
Oral hairy leukoplakia
Acute necrotizing ulcerative gingivitis or periodontitis
Lymph node tuberculosis
Pulmonary tuberculosis
Severe recurrent bacterial pneumonia
Symptomatic lymphoid interstitial pneumonitis
Chronic HIV-associated lung disease including brochiectasis
Unexplained anaemia (9 per litre) and or chronic thrombocytopaenia (9per litre)

Clinical stage 4

Unexplained’ severe wasting or severe mainutnuon not responding to standard therapy
Pneumocystis pneumonia
Recurrent severe bacterial chest infections (such as empyema, pyomyosrtts, bone or joint infection or meningitis but excluding pneumonia)
Chronic herpes simplex infection (orolanial or cutaneous of more than one month’s
Duration or visceral at any site)
Oesophageal candidiasis (or candidiasis of trachea, bronchi or lungs) Extrapulmonary tuberculosisKaposi sarcoma (in adult)
Cylomegalovirus infection: retintlis or cytomegalovirus infection affecting another organ, with onset at age older than one month
Central nervous system toxoplasmosis (after one month of lite)
Extrapulmonary cryptococcosis (including meningitis)
HIV encephalopathy
Disseminated endemic mycosis (coccidiomycosis or histoplasmosis) Disseminated non-tuberculous rnycobacterial infection
Chronic cryptosporidiosis (with diarrhoe)
Chronic isosporiasis
Cerebral or B-cell non-Hodgkin lymphoma
Progressive multifocal leukoencephalopathy
Depression is most common psychological feature
Symptomatic HIV-associated nephropathy or HIV-associated cardiomyopathy

DISEASES ASSOCIATED WITH AIDS:

Necrotizing Granuloma

Granulomatous inflammation begins with the uptake of foreign antigens by macrophages.
These cells process and present the antigen to helper T lymphocytes
Activate macrophages by interferon-γ secretion.
Infectious granulomas are necrotizing
Non-infectious granulomas are non-necrotizing.
Mycobacterial infections are of utmost importance in AIDS.
Caseating necrosis is pathognomonic of mycobacterial infection.
Lung biopsy shows multiple nodular lesions
Consisting of large epithelioid cells surrounded by lymphocytes and fibroblasts.
There is an area of necrosis in the center of some nodules.
Numerous acid-fast bacilli are demonstrated by Ziehl-Neelsen staining within the cytoplasm of epithelioid cells.

Progressive Multifocal Leukoencephalopathy

Rapidly progressive demyelinating disorder
JC virus (a papovavirus) infects oligodendroglial cells in the brain.
PML occurs in about 1% of AIDS patients.
No effective treatment .
Shows hemiparesis, ataxia, homonymous hemianopia, and cognitive deterioration.
MRI of the brain demonstrates widespread areas of abnormal T2 signal in the white matter.
An electroencephalogram is remarkable for diffuse slowing over both cerebral hemispheres.
Brain biopsy reveals demyelination with abnormal giant oligodendrocytes, some of which contain eosinophilic inclusions.

Misc

HIV in children, characteristic finding is Recurrent chest infection
Feature of HIV infection in childhood Failure to thrive is universal, Lymphadenopathy, P. Carinii pneumonia, M.C. AIDS defining illness in children,
Depression is the most common psychological features of AIDS
Teratogenic effects are rare with HIV infections

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