WHO Staging of HIV and AIDS.ppt

health

1. Staging for HIV Infection
Wilson Okumu

2. 2
Learning Outcomes
•Bytheendofthissession,youwillbe
expectedtobeableto:
•DiscussdiseasestagingandAIDS-defining
illnessbasedonWHOguidelines

3. 3
What is Staging?
•Classificationoftheparticularstagereached
byaprogressivedisease

4. 4
Why is Staging Important in HIV?
•TrackingandmonitoringtheHIV
epidemic
•Providingcliniciansandpatientswith
importantinformationaboutHIVdisease
stageandclinicalmanagement

5. 5
What are the Staging Systems in use?
(1)U.S.CentersforDiseaseControland
Prevention(CDC)classificationsystem
(2)WorldHealthOrganization(WHO)
ClinicalStagingandDisease
ClassificationSystem

6. 6
We will focus on WHO
clinical staging systems

7. 7
Phases of HIV disease

8. 8
Three Phases of HIV Infection
•CoursetakenbyHIVisunderstoodintermsof
interplaybetweenHIVandtheimmunesystem.

9. 9
Phase I-The early, acute phase
•InitialresponseofanimmunocompetentadulttoHIV
infection
•Highlevelofvirusproductionandviraemia
widespreadviralseedingofthelymphoidtissuesand
1-2billionCD4+T-cellsdieeachday
•Clinicallycharacterizedbyinfectiousmononucleosis-
likefeaturesofsorethroat,myalgias,fever,weight
loss,andfatigue

10. 10
Phase II-The middle, Chronic Phase
•Relativecontainmentofthevirusandclinicallatency
•Virusreplicationcontinuesforseveralyears,
•predominantlyinthelymphoidtissues
•Immunesystemlargelyintact
•Clinically,patientsareeitherasymptomaticor
developpersistentgeneralizedlymphadenopathy
(PGL).
•Manypatientshaveherpeszoster,oralthrush
21

11. 11
Phase III-The Final Phase
•Breakdownofhostdefense
•CD4countusually<200cells/mm
3
•Suddenandrapidviraemia
•Clinically,thepatientpresentswithmarkedweight
loss,
•Chronicdiarrhoea,andfeverlastingmorethan1
month
•Opportunisticinfections(OI)occur
•TheclinicalpictureofAIDSwilldependonthetype
ofOI
22

12. 12
Phase of HIV and AIDS
•Fourphasesemergefromdayzero
–Infection
–Windowperiod
–Seroconversion
–Asymptomaticperiod
–HIV/AIDS-relatedillness
•AIDS

13. 13
CD4 Counts
•NumberofCD4cellsinbloodprovidesa
measureofimmunesystemdamage
•CD4countreflectsphaseofdisease
•CD4count:
–500–1200:Normal
–200–500:BeginningofHIVillness
–<200: AIDS

14. 14
Window Period
•Timebetweeninfection&enough
antibodiesforapositiveHIVtest
•Duration:approximately3months
•Nosymptomsorsignsofillness
•HIVtestisnegative
•Virusismultiplyingrapidly-viralloadis
high
•Personisveryinfectious

15. 15
Seroconversion
•PointatwhichHIVtestbecomespositive
•BodystartsmakingantibodiestoHIVafew
weeksafterinfection
•HIVtestbecomespositivewhenantibody
levelsarehighenoughtobemeasured
•Happensabout3monthsafterinfection
•Personmayhaveamildflu-likeillness,
lastingaweekortwothenthepersoniswell
again

16. 16
Asymptomatic Periodic
•Timeperiodbetweenseroconversionand
onsetofHIV/AIDS-relatedillness
•Durationvariable:<1yearto>15years
•Most peopleremainhealthy
(asymptomatic)foraboutthreeyears
•Durationmaydependonsocio-economic
factors
•TheCD4countisabove500cells/ml

17. 17
HIV-Related Illnesses & AIDS
•Timeperiodbetweenonsetofillness&
diagnosisofAIDS
•Durationisvariable:averageabout5
years
•Illnessesinitiallymild,withgradual
increaseinfrequencyandseverity
•CD4countisbetween500&200cells/ml

18. 18
AIDS
•FinalphaseofHIV/AIDS
•Duration:withoutantiretroviraldrugs,less
than2yearswithandwithantiretrovirals,
manymanyyears
•CD4countisbelow200cells/ml
•Viralloadsarehigh&thepersonisvery
infectious
•HIVtestmaybecomenegative

19. 19
WHO Clinical Staging of
HIV/AIDS

20. 20
WHO Clinical Staging in Adults
AdultswithHIVinfectionareclassifiedinto4
clinicalstagesdependingonthepresenceof
HIV-relatedconditions

21. 21
WHO Clinical Staging Criteria?
Classification WHO clinical stage
Asymptomatic 1
Mild 2
Advanced 3
Severe 4

22. WHO Clinical Stage 1-Primary HIV
Infection
•Asymptomatic
•PersistentGeneralized
Lymphadenopathy(PGL)
•Performance scale 1: asymptomatic,
normal activity

23. WHO Clinical Stage II-Asymptomatic
•Weightloss,<10%ofbodyweight
•Minormucocutaneousmanifestations(seborrheic
dermatitis,prurigo,
•Fungalnailinfections,recurrentoralulcerations,
angularcheilitis
•Herpeszosterwithinthelastfiveyears
•Recurrentupperrespiratorytractinfections
•And/orperformancescale2:symptomatic,normal
activity.

24. WHO Clinical Stage III-
Asymptomatic
24

25. WHO Clinical Stage IV-(HIV to AIDS)
•HIVwastingsyndrome,asdefinedbythe
CentersforDiseaseControlandPrevention
•Pneumocystiscariniipneumonia
•Toxoplasmosisofthebrain
•Cryptosporidiosiswithdiarrhoea>1month
•Cryptococcosis,extrapulmonary
•Cytomegalovirusdiseaseofanorganotherthan
liver,spleenorlymphnodes
•Herpessimplexvirusinfection,mucocutaneous
>1month,orvisceralanyduration
•Progressivemultifocalleukoencephalopathy

26. 26
WHOClinicalStageIV-(HIVtoAIDS)
•Any disseminated endemic mycosis
(i.e.histoplasmosis,coccidioidomycosis)
•Candidiasisoftheoesophagus,trachea,bronchior
lungs
•Atypicalmycobacteriosis,disseminated
•Non-typhoidSalmonellasepticaemia
•Extrapulmonarytuberculosis
•Lymphoma
•Kaposi’ssarcoma
•HIVencephalopathy,asdefinedbytheCentersfor
DiseaseControlandPrevention.
•And/orperformancescale4:bedridden>50%ofthe
dayduringthelastmonth
32

27. 27
ReferencesCited
•WHOCaseDefinitionsofHIVforSurveillanceand
RevisedClinicalStagingandImmunological
ClassificationofHIV-RelatedDiseaseinAdultsand
Children;2007.
•1993revisedclassificationsystemforHIVinfectionand
expandedsurveillancecasedefinitionforAIDSamong
adolescentsandadults.MMWRRecommRep.1992Dec
18;41(RR-17):1-19.
•Guidelinesfornationalhumanimmunodeficiencyvirus
casesurveillance,includingmonitoringforhuman
immunodeficiencyvirusinfectionandacquired
immunodeficiencysyndrome.MMWR RecommRep.
1999Dec10;48(RR-13):1-27,29-31.