Diagnosis of AIDS in Adults

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Diagnosis of AIDS in the Adolescent (>13 Years) and Adults

1993 Revised Classification system for HIV Infection and Expanded Aids Surveillance Cases Definition for Adolescents and Adults *
CD4+T-Cell Categories	CLINICAL CATEGORIES
CD4+T-Cell Categories	(A) Asymptomatic, Acute (primary) HIV or PGL**	(B) Symptomatic, not A or C Conditions ß	(C) AIDS - indicator conditions ¶
(1) >500/µL	A1	B1	C1
(2) 200-499/µL	A2	B2	C2
(3) <200/µL AIDS-indicate T-cell	A3	B3	C3

* The bolded cells illustrate the expanded AIDS surveillance case definition. Persons with AIDS-indicator conditions (Category C) as well as those with CD4 + T-lymphocyte counts < 200/uL (Categories A3 or B3) will be reportable as AIDS cases in the U.S. and Territories effective January 1, 1993.

** PGL - Persistent generalized lymphadenopathy. Clinical Category A includes acute (primary) HIV infection.
ß See VII E, 2b above
¶ See VII F, below

Category A: Consists of one or more of the conditions listed below in an adolescent or adult ( 13 years) with documented HIV infection.
Conditions listed in Categories B and C must not have occurred.

Asymptomatic HIV infection
Persistent generalized lymphadenopathy
Accompanying illness or history of acute HIV infection

Category B: Consists of symptomatic conditions in an HIV infected adolescent or adult that are not included among conditions listed in clinical Category C and that meet at least one of the following criteria:

The conditions are attributed to HIV infection or are indicative of a defect in cell-mediated immunity, or
The conditions are considered by physicians to have a clinical course or to require management that is complicated by HIV infections.

but are not limited to

Bacillary angiomatosis
Candidiasis, oropharyngeal (thrush)
Candidiasis, vulvovaginal; persistent, frequent or poorly responsive to therapy
Cervical dysplasia (moderate or severe)/cervical carcinoma in situ
Constitutional symptoms, such as fever (38.5 C) or diarrhea lasting > 1 month
Hairy leukoplakia, oral
Herpes zoster (shingles), involving at least two distinct episodes or more than one dermatome
Idiopathic thrombocytopenia purpura
Listeriosis
Pelvic inflammatory disease, particularly if complicated by tubo-ovarian abscess
Peripheral Neuropathy - For classification purposes,
Category B conditions take precedence overthose in Category A.
For example, someone previously treated for oral or persistent vaginal candidiasis (and who has not developed a Category C disease) but who is non asymptomatic, should be classified in clinical Category B.

Category C: Includes the clinical conditions listed in the AIDS surveillance case definition (VII F). For classification purposes, once a Category C condition has occurred, the person will remain in Category C.

F. Conditions included in the 1993 Aids Surveillance Case Definition

Candidiasis of the trachea, bronchi, or lungs
Candidiasis of the esophagus
Cervical carcinoma, invasive *
Coccidioidomycosis, disseminated or extra pulmonary
Cryptococcoses, extra pulmonary
Cryptosporidiosis, chronic intestinal (>1 month's duration)
Cytomegalovirus disease (other than liver, spleen, nodes) Cytomegalovirus retinitis (with loss of vision)
Encephalopathy; HIV related
Herpes simplex: Chronic ulcer(s) (>1 month duration) or bronchitis, pneumonitis or esophagitis
Histoplasmosis, disseminated or extra pulmonary
Isosporiasis, chronic intestinal (>1 month duration)
Kaposi's sarcoma
Lymphoma, primary brain
Lymphoma (immunoblastic or equivalent term)
Mycobacterium avium complex or Mycobacterium kansasii, disseminated or extra pulmonary
Mycobacterium tuberculosis, any site, (pulmonary* or extra pulmonary)
Mycobacterium, other species or unidentified species disseminated or extra pulmonary
Pneumocystis carinii pneumonia= PCP pneumonia
Progressive multifocal leukoencephalopathy
Pneumonia, recurrent*
Salmonella septicemia, recurrent
Toxoplasmosis of brain
Wasting syndrome due to HIV

* Added in the 1993 expansion of the AIDS surveillance case definition

From the A Manual for the Management of HIV Infections in Infants, Children, and Adolescents by William S. Foshee, M.D., is an Associate Professor of Pediatrics at The Medical College of Georgia/Children's Medical Center and Educational Coordinator for Pediatrics at University Hospital in Augusta, Georgia.

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