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HIV Clinical Staging
HAIVNHarvard Medical School AIDS
Initiative in Vietnam
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Learning Objectives
By the end of this session, participants should be able to:
Determine the clinical stage of an HIV patient
Explain when to evaluate the clinical stage of the patient
Explain how to apply clinical staging before and after ARV treatment
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WHO Clinical Staging System
WHO Clinical Stage can be used to: Estimate degree of damage done to a
patient’s immune system Follow progression of HIV disease Determine when to start:• prophylactic treatment with cotrimoxazole • antiretroviral therapy (ART)
Follow patient’s response to ART
WHO Clinical Stage should be evaluated at every clinic visit
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Application of Clinical Staging in Relation to ARV Treatment
Before ARV: Identify highest
clinical stage patient has reached
Reason: Determine eligibility for ARV treatment
After Starting ARV: Re-evaluate
current clinical status of patient
Reason: Assess the improvement of clinical status and the response to ARV treatment
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WHO Clinical Stages
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Stage 1: Asymptomatic
Most typical/common syndromes: Asymptomatic Persistent generalized
lymphadenophathy
Performance Scale: Normal activity
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Stage 2: Mildly Symptomatic
Most typical/common syndromes: Moderate unexplained weight loss (<
10% of body weight) Recurrent respiratory infections Zona (Herpes zoster) Papular pruritic eruption (PPE)
Performance Scale: symptomatic but normal activity
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Stage 3: Progressively Symptomatic
Most typical/common syndromes: Unexplained:• severe weight loss (> 10% of body weight)• chronic diarrhea for > 1 month• persistent fever for > 1 month
Recurrent oral candidiasis Pulmonary tuberculosis Severe bacterial infections Unexplained anemia, neutropenia, or
thrombocytopenia
Performance Scale: symptomatic, in bed < 50% of the time
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Stage 4: Severely Symptomatic
Most typical/common syndromes: Extrapulmonary tuberculosis Pneumocystis jiroveci Pneumonia (PCP) Esophageal candidiasis CNS Toxoplasmosis Cryptococcal meningitis Penicilliosis CMV retinitis
Performance Scale: bedridden > 50% of the time
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What is her Clinical Stage?
Nguyet was treated for lymph node TB from January to September 2009. Currently she has no fever or other symptoms of an OI. She lost 12 kg before TB treatment and gained 6 kg after treatment. She is not yet on ARV.
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What is her Clinical Stage?
6 months after starting ARV Nguyet has gained another 3 kg. She feels well but now has herpes zoster (zona) on her left side.
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Immunological Staging
Severity CD4 mm3
Normal or unremarkable deficiency
> 500
Mild deficiency 350 - 499
Progressive deficiency 200 - 349
Severe deficiency < 200
Immune status is evaluated by CD4 cell count
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Criteria for Diagnosis of Advanced HIV Infection (Including AIDS)
Advanced HIV Infection:
Having any clinical stage 3 or 4 condition (presumptive or definitive diagnosis)
and/or CD4 cell count <
350 cells/mm3
AIDS: Having any clinical
stage 4 condition (presumptive or definitive diagnosis)
or CD4 cell count <
200 cells/mm3
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Key Points
WHO clinical staging classifies patient into 4 categories based on clinical symptoms
Perform clinical staging at each visit to:• determine eligibility for ART• assess patient’s response to ART
CD4 count, clinical staging are used to:• evaluate status of patient’s immune
system• decide when to start OI prophylaxis and
ART
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Thank you!
Questions?