WHO clinical staging of HIV disease in adults, adolescents and children

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Consolidated Guidelines on the Use of Antiretroviral Drugs for Treating and Preventing HIV Infection: Recommendations for a Public Health Approach. 2nd edition. Geneva: World Health Organization; 2016.

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Consolidated Guidelines on the Use of Antiretroviral Drugs for Treating and Preventing HIV Infection: Recommendations for a Public Health Approach. 2nd edition.

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ANNEX 10WHO clinical staging of HIV disease in adults, adolescents and children

Adults and adolescents^a	Children
Clinical stage 1
Asymptomatic Persistent generalized lymphadenopathy	Asymptomatic Persistent generalized lymphadenopathy
Clinical stage 2
Moderate unexplained weight loss (<10% of presumed or measured body weight) Recurrent respiratory tract infections (sinusitis, tonsillitis, otitis media, pharyngitis) Herpes zoster Angular cheilitis Recurrent oral ulceration Papular pruritic eruption Fungal nail infections Seborrhoeic dermatitis	Unexplained persistent hepatosplenomegaly Recurrent or chronic upper respiratory tract infections (otitis media, otorrhoea, sinusitis, tonsillitis) Herpes zoster Lineal gingival erythema Recurrent oral ulceration Papular pruritic eruption Fungal nail infections Extensive wart virus infection Extensive molluscum contagiosum Unexplained persistent parotid enlargement
Clinical stage 3
Unexplained severe weight loss (>10% of presumed or measured body weight) Unexplained chronic diarrhoea for longer than 1 month Unexplained persistent fever (intermittent or constant for longer than 1 month) Persistent oral candidiasis Oral hairy leukoplakia Pulmonary tuberculosis Severe bacterial infections (such as pneumonia, empyema, pyomyositis, bone or joint infection, meningitis, bacteraemia) Acute necrotizing ulcerative stomatitis, gingivitis or periodontitis Unexplained anaemia (<8 g/dl), neutropaenia (<0.5 × 10⁹/L) and/or chronic thrombocytopaenia (<50 × 10⁹/L)	Unexplained moderate malnutrition^b 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 1 month) Persistent oral candidiasis (after first six weeks of life) Oral hairy leukoplakia Lymph node tuberculosis; pulmonary tuberculosis Severe recurrent bacterial pneumonia Acute necrotizing ulcerative gingivitis or periodontitis Unexplained anaemia (<8 g/dL), neutropaenia (<0.5 × 10⁹/L) or chronic thrombocytopaenia (<50 × 10⁹/L)
Clinical stage 3
	Symptomatic lymphoid interstitial pneumonitis Chronic HIV-associated lung disease, including bronchiectasis
Clinical stage 4^c
HIV wasting syndrome Pneumocystis (jirovecii) pneumonia Recurrent severe bacterial pneumonia Chronic herpes simplex infection (orolabial, genital or anorectal of more than one month in duration or visceral at any site) Oesophageal candidiasis (or candidiasis of trachea, bronchi or lungs) Extrapulmonary tuberculosis Kaposi sarcoma Cytomegalovirus infection (retinitis or infection of other organs) Central nervous system toxoplasmosis HIV encephalopathy Extrapulmonary cryptococcosis, including meningitis Disseminated nontuberculous mycobacterial infection Progressive multifocal leukoencephalopathy Chronic cryptosporidiosis Chronic isosporiasis Disseminated mycosis (extrapulmonary histoplasmosis, coccidioidomycosis) Lymphoma (cerebral or B-cell non-Hodgkin) Symptomatic HIV-associated nephropathy or cardiomyopathy Recurrent septicaemia (including nontyphoidal Salmonella) Invasive cervical carcinoma Atypical disseminated leishmaniasis	Unexplained severe wasting, stunting or severe malnutrition^d not responding to standard therapy Pneumocystis (jirovecii) pneumonia Recurrent severe bacterial infections (such as empyema, pyomyositis, bone or joint infection, meningitis, but excluding pneumonia) Chronic herpes simplex infection (orolabial or cutaneous of more than 1 month's duration or visceral at any site) Oesophageal candidiasis (or candidiasis of trachea, bronchi or lungs) Extrapulmonary tuberculosis Kaposi sarcoma Cytomegalovirus infection (retinitis or infection of other organs with onset at age older than one month) Central nervous system toxoplasmosis (after the neonatal period) HIV encephalopathy Extrapulmonary cryptococcosis, including meningitis Disseminated nontuberculous mycobacterial infection Progressive multifocal leukoencephalopathy Chronic cryptosporidiosis (with diarrhoea) Chronic isosporiasis Disseminated endemic mycosis (extrapulmonary histoplasmosis, coccidioidomycosis, penicilliosis) Cerebral or B-cell non-Hodgkin lymphoma HIV-associated nephropathy or cardiomyopathy

a: In the development of this table, adolescents were defined as 15 years or older. For those younger than 15 years, the clinical staging for children should be used.
b: For children younger than 5 years, moderate malnutrition is defined as weight-for-height < −2 z-score or mid-upper arm circumference ≥115 mm to <125 mm.
c: Some additional specific conditions can be included in regional classifications, such as penicilliosis in Asia, HIV-associated rectovaginal fistula in southern Africa and reactivation of trypanosomiasis in Latin America.
d: For children younger than five years of age, severe wasting is defined as weight-for-height < −3 z-score; stunting is defined as length-for-age/height-for-age < −2 z-score; and severe acute malnutrition is either weight for height < −3 z-score or mid-upper arm circumference <115 mm or the presence of oedema.
: Source: Adapted from: WHO case definitions of HIV for surveillance and revised clinical staging and immunological classification of HIV-related disease in adults and children. Geneva: World Health Organization; 2007. (www.who.int/hiv/pub/guidelines/HIVstaging150307.pdf).

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Consolidated Guidelines on the Use of Antiretroviral Drugs for Treating and Preventing HIV Infection: Recommendations for a Public Health Approach. 2nd edition. Geneva: World Health Organization; 2016. ANNEX 10, WHO clinical staging of HIV disease in adults, adolescents and children.
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