AIDS defining clinical condition

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editors-in-Chief: Ujjwal Rastogi, MBBS [2]

Overview

AIDS is defined as an the presence of either of the following in a patient with HIV infection: a CD4+ T-cell count below 200 cells/µl, a CD4+ T-cell percentage of total lymphocytes of less than 15%, any of the 27 specified AIDS-defining illnesses.

Definition

AIDS Case Definition
According to the CDC definition, a patient has AIDS if he or she is infected with HIV and presents with one of the following:
A CD4+ T-cell count below 200 cells/µl
OR
A CD4+ T-cell percentage of total lymphocytes of less than 15%
OR
Has one of the defining conditions.

If a patient presents with one of the above conditions but with a negative HIV test, he or she will not normally be considered to have AIDS. However, an AIDS diagnosis may be given if the patient has had Pneumocystis jiroveci pneumonia, and one of the following conditions:
Has not undergone high-dose corticoid therapy or other immunosuppressive/ cytotoxic therapy in the three months before the onset of the indicator disease
OR
Has been diagnosed with Hodgkin’s disease, Non-Hodgkin’s lymphoma, lymphocytic leukemia, multiple myeloma, or any cancer of lymphoreticular or histiocytic tissue, orangioimmunoblastic lymphoadenopathy
OR
Has been diagnosed with a genetic immunodeficiency syndrome atypical of HIV infection, such as one involving hypogamma globulinemia.

AIDS-Defining Illnesses

In 1993, the CDC added pulmonary tuberculosis, recurrent pneumonia, and invasive cervical cancer to the list of clinical conditions in the AIDS surveillance case definition published in 1987 and expanded the AIDS surveillance case definition to include all HIV-infected persons with CD4+ T-lymphocyte counts of less than 200 cells/uL or a CD4+ percentage of less than 14. Considerable variation exists in the relative risk of death following different AIDS defining clinical conditions.

List of AIDS-defining Illnesses

Candidiasis of bronchi, trachea, or lungs
Candidiasis esophageal
Coccidioidomycosis, disseminated or extrapulmonary
Cryptococcosis, extrapulmonary
Cryptosporidiosis, chronic intestinal for longer than 1 month
Cytomegalovirus disease (other than liver, spleen or lymph nodes)
Cytomegalovirus retinitis (with loss of vision)
Encephalopathy (HIV-related)
Herpes simplex: chronic ulcer(s) (for more than 1 month); or bronchitis, pneumonitis, or esophagitis
Histoplasmosis, disseminated or extrapulmonary
Isosporiasis, chronic intestinal (for more than 1 month)
Kaposi’s sarcoma
Lymphoma, Burkitt’s
Lymphoma, immunoblastic (or equivalent term)
Lymphoma, primary, of brain
Mycobacterium avium complex or Mycobacterium kansasii, disseminated or extrapulmonary
Mycobacterium, other species, disseminated or extrapulmonary
Mycobacterium tuberculosis, any site (extrapulmonary)
Pneumocystis jiroveci pneumonia (formerly Pneumocystis carinii)
Progressive multifocal leukoencephalopathy
Salmonella septicemia (recurrent)
Toxoplasmosis of the brain
Tuberculosis, disseminated
Wasting syndrome due to HIV
Cervical cancer (invasive)
Mycobacterium tuberculosis, any site (pulmonary)
Pneumonia (recurrent)

Children < 13 years

Additional conditions are included for children less than 13:^[1]

Bacterial infections, multiple or recurrent
Lymphoid interstitial pneumonia or pulmonary lymphoid hyperplasia complex

References

↑ Schneider E, Whitmore S, Glynn KM, Dominguez K, Mitsch A, McKenna MT (2008). “Revised surveillance case definitions for HIV infection among adults, adolescents, and children aged <18 months and for HIV infection and AIDS among children aged 18 months to <13 years–United States, 2008”. MMWR Recomm Rep. 57 (RR-10): 1–12. PMID 19052530. Unknown parameter |month= ignored (help)

CDC. Revision of the CDC surveillance case definition for acquired immunodeficiency syndrome. MMWR 1987;36:1-15S.
CDC. 1993 Revised Classification System for HIV Infection and Expanded Surveillance Case Definition for AIDS Among Adolescents and Adults
AIDS info
Disease progression and survival following specific AIDS-defining conditions: a retrospective cohort study of 2048 HIV-infected persons in London.

[pmid19052530-1] Schneider E, Whitmore S, Glynn KM, Dominguez K, Mitsch A, McKenna MT (2008). “Revised surveillance case definitions for HIV infection among adults, adolescents, and children aged <18 months and for HIV infection and AIDS among children aged 18 months to <13 years–United States, 2008”. MMWR Recomm Rep. 57 (RR-10): 1–12. PMID 19052530. Unknown parameter |month= ignored (help)

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