¹ Weekly epidemiological record, 65: 221-228 (1990).

The WHO Global Programme on AIDS has issued the following proposed clinical staging system for HIV infection and disease. Based primarily on clinical criteria, the system is organized into four prognostic categories. It also incorporates a performance scale based on the Eastern Cooperative Oncology Group score.

Clinical stage 1:

1. Asymptomatic.

2. Persistent generalized lymphadenopathy (PGL).

Performance scale 1: asymptomatic, normal activity.

Clinical stage 2:

3. Weight loss of < 10% of body weight.

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

5. Herpes zoster, within the last 5 years.

6. Recurrent upper respiratory tract infection (i.e., bacterial sinusitis).

And/or Performance scale 2: symptomatic, normal activity.

Clinical stage 3:

7. Weight loss of > 10% of body weight.

8. Unexplained chronic diarrhoea, > 1 month.

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

10. Oral candidiasis (thrush).

11. Oral hairy leukoplakia.

12. Pulmonary tuberculosis, within the past year.

13. Severe bacterial infections (i.e., pneumonia, pyomyositis).

And/or Performance scale 3: bed-ridden <50% of the day during the last month.

Clinical stage 4:

14. HIV wasting syndrome, as defined by the Centers for Disease Control (CDC).²

² HIV wasting syndrome: Weight loss of > 10% of body weight, plus either unexplained chronic diarrhoea (> 1 month), or chronic weakness and unexplained prolonged fever (> 1 month).

15. Pneumocystis carinii pneumonia.

16. Toxoplasmosis of the brain.

17. Cryptosporidiosis with diarrhoea, > 1 month.

18. Cryptococcosis, extrapulmonary.

19. Cytomegalovirus (CMV) disease of an organ other than liver, spleen, or lymph nodes.

20. Herpes simplex virus (HSV) infection, mucocutaneous (> 1 month) or visceral (any duration).

21. Progressive multifocal leukoencephalopathy (PML).

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

23. Candidiasis of the oesophagus, trachea, bronchi, or lungs.

24. Atypical mycobacteriosis, disseminated.

25. Non-typhoid Salmonella septicaemia.

26. Extrapulmonary tuberculosis.

27. Lymphoma.

28. Kaposi sarcoma (KS).

29. HIV encephalopathy, as defined by CDC.¹

¹ 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 that could explain the findings.

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

(Note: Both definitive and presumptive diagnoses are acceptable.)