Appendix B: WHO Staging System for HIV Infection and Disease in Adults and Adolescents

Adult Clinical Stage I:

1. Asymptomatic

2. Generalized lymphadenopathy

Performance scale 1: asymptomatic, normal activity

Adult Clinical Stage II:

1. Weight loss <10% of body weight

2. Minor mucocutaneous manifestations (seborrhoeic dermatitis, prurigo, fungal nail infections, recurrent oral ulcerations, angular cheilitis)

3. Herpes zoster within the last five years

4. Recurrent upper respiratory tract infections (i.e., bacterial sinusitis)

And/or performance scale 2: symptomatic, normal activity

Adult Clinical Stage III:

1. Weight loss >10% of body weight

2. Unexplained chronic diarrhea >1 month

3. Unexplained prolonged fever (intermittent or constant) >1 month

4. Oral candidiasis

5. Oral hairy leukopenia

6. Pulmonary tuberculosis

7. Severe bacterial infections (i.e. pneumonia, pyomyositis, S. typhi)

And/or performance scale 3: bedridden <50% of the day during last month

Adult Clinical Stage IV:

1. HIV wasting syndromea

2. Pneumocystic carinii pneumonia or subacute dyspnea with exam or x-ray consistent with PCP

3. Seizures or focal neurological findings

4. Toxoplasmosis of the brain

5. Cryptosporidiosis with diarrhea >1 month

6. Cryptococcosis, extrapulmonary

7. Cytomegalovirus disease of an organ other than liver, spleen, or lymph node (e.g., retinitis)

8. Herpes simplex virus infection, mucocutaneous (>1 month) or visceral

9. Progressive multifocal leukoencephalopathy

10. Any disseminated endemic mycosis (i.e., histoplasmosis, coccidioidomycosis)

11. Candidiasis of esophagus, trachea, bronchi

12. Atypical mycobacteriosis, disseminated or pulmonary

13. Non-typhoid Salmonella septicaemia

14. Extrapulmonary tuberculosis

15. Lymphoma

16. Kaposi’s sarcoma

17. HIV encephalopathyb

18. Subacute meningitis consistent with cryptococcus or tuberculosis

And/or performance scale 4: bedridden >50% of the day during last month

Adapted from: World Health Organization. Scaling up antiretroviral therapy in resource-limited settings: treatment guidelines for a public health approach. Geneva: World Health Organization, 2004:61. (Accessed July 9, 2006 at: http://www.who.int/3by5/publications/documents/arv_guidelines/en/index.html.)

a HIV wasting syndrome: weight loss of >10% of body weight, plus either unexplained chronic diarrhea (>1 month) or chronic weakness and unexplained prolonged fever (>1 month).

b HIV encephalopathy: clinical findings of disabling cognitive and/or motor dysfunction interfering with activities of daily living, progressing over weeks to months, in the absence of a concurrent illness or condition, other than HIV infection, which could explain the findings.