Spectrum: Local Antimicrobial Stewardship, for Yangon Children's Hospital

Staging of HIV Infection

After the HIV infection is confirmed, staging should be done using the WHO clinical staging of HIV/AIDS for infants and children which provides guidance on when to start, stop, or substitute antiretroviral therapy in HIV-infected children

Clinical Criteria

Clinical Stage 1 (Asymptomatic)

  • Asymptomatic

  • Persistent generalized lymphadenopathy

Clinical Stage 2 (Mild)

  • Unexplained persistent hepatosplenomegaly

  • Papular pruritic eruptions

  • Extensive wart virus infection

  • Extensive molluscum contagiosum

  • Recurrent oral ulcerations

  • Unexplained persistent parotid enlargement

  • Lineal gingival erythema

  • Herpes zoster

  • Recurrent or chronic upper respiratory tract infections (otitis media, otorrhoea, sinusitis, tonsillitis)

Clinical Stage 3 (Advanced)

  • Moderate unexplained malnutrition not adequately responding to standard therapy

    • For children <5 years, moderate malnutrition is defined as weight-for-height less than -2 Z-score or mid-upper arm circumference ≥115mm to <125mm

  • Unexplained persistent diarrhea (≥14 days)

  • Unexplained persistent fever (>37.5ºC, intermittent or constant, for longer than one month)

  • Persistent oral candida (outside first 6-8 weeks of life)

  • Oral hairy leukoplakia

  • Acute necrotizing ulcerative gingivitis/periodontitis

  • Lymph node TB

  • Pulmonary tuberculosis

  • Severe recurrent presumed bacterial pneumonia

  • Symptomatic lymphoid interstitial pneumonitis

  • Chronic HIV-associated lung disease, including bronchiectasis

  • Unexplained anemia (<8g/dL), neutropenia (<0.5x10⁹/L), or chronic thrombocytopenia (<50x10⁹/L)

Clinical Stage 4 (Severe)

  • Unexplained severe wasting, stunting, or severe malnutrition not responding to standard therapy

    • For children <5 years: Severe wasting is defined as weight-for-height less than -3 Z-score; stunting is defined as length-for-age/height-for-age less than -2 Z-score; severe acute malnutrition is either weight-for-height less than -3 Z-score, or mid-upper arm circumference <115mm, or presence of oedema

  • Pneumocystis jiroveci pneumonia

  • Recurrent severe presumed bacterial infections (e.g. empyema, pyomyositis, bone or joint infection, meningitis, but excluding pneumonia)

  • Chronic herpes simplex infection (orolabial or cutaneous >1 month duration or visceral at any site)

  • Extrapulmonary tuberculosis

  • Kaposi sarcoma

  • Oesophageal candidiasis (or candida of trachea, bronchi, or lungs)

  • Central nervous system toxoplasmosis (outside the neonatal period)

  • HIV encephalopathy

  • Cytomegalovirus (CMV) retinitis or CMV infection affecting another organ, with onset at >1 month of age

  • Extrapulmonary cryptococcosis including meningitis

  • Disseminated endemic mycosis (extrapulmonary histoplasmosi, coccidiomycosis, talaromycosis [formerly penicilliosis])

  • Chronic Cryptosporidiosis (with diarrhoea)

  • Chronic Isosporiasis

  • Disseminated non-tuberculous mycobacterial infection

  • Cerebral or B cell non-Hodgkin lymphoma

  • Progressive multifocal leukoencephalopathy

  • HIV-associated cardiomyopathy or HIV-associated nephropathy

Immunological Criteria

WHO classification of HIV - Associated immunodeficiency using age-related CD4 values:

<11 months

Not significant: >35%
Mild: 30-35%
Advanced: 25-30%
Severe: <25%

12-35 months

Not significant: >30%
Mild: 25-30%
Advanced: 20-25%
Severe: <20%

36-59 months

Not significant: >25%
Mild: 20-25%
Advanced: 15-20%
Severe: <15%

≥5 years

Not significant: >500 cells/mm³
Mild: 350-499 cells/mm³
Advanced: 200-349 cells/mm³
Severe: <200 cells/mm³ or <15%