AIDS defining clinical condition

Associate Editors-in-Chief: Ujjwal Rastogi, MBBS [mailto:urastogi@perfuse.org]

Overview
AIDS defining clinical conditions is the terminology given to a list of diseases published by the United States government run Centers for Disease Control and Prevention (CDC). This list governs the U.S. government classification of HIV disease. This is to allow the government to handle epidemic statistics and define who receives US government assistance.

Considerable variation exists in the relative risk of death following different AIDS defining clinical conditions.

Definition
According to the US CDC definition, a patient has AIDS if he or she is infected with HIV and presents with one of the following:

A CD4+ T-cell count below 200 cells/µl (or a CD4+ T-cell percentage of total lymphocytes of less than 15%)

or

the patient has one of the defining illnesses.

People who are not infected with HIV may also develop these conditions; this does not mean they have AIDS. However, when an individual presents laboratory evidence against HIV infection, a diagnosis of AIDS is ruled out unless:

the patient has not undergone high-dose corticoid therapy or other immunosuppressive/cytotoxic therapy in the three months before the onset of the indicator disease OR been diagnosed with Hodgkin's disease, non-Hodgkin's lymphoma, lymphocytic leukemia, multiple myeloma, or any cancer of lymphoreticular or histiocytic tissue, or angioimmunoblastic lymphoadenopathy OR a genetic immunodeficiency syndrome atypical of HIV infection, such as one involving hypogamma globulinemia

AND

the individual has had Pneumocystis jiroveci pneumonia OR one of the above defining illnesses AND a CD4+ T-cell count below 200 cells/µl (or a CD4+ T-cell percentage of total lymphocytes of less than 14%).

In 1993, the CDC added pulmonary tuberculosis, recurrent pneumonia, and invasive cervical cancer to the list of clinical conditions in the AIDS surveillance case definition published in 1987 and expanded the AIDS surveillance case definition to include all HIV-infected persons with CD4+ T-lymphocyte counts of less than 200 cells/uL or a CD4+ percentage of less than 14. Considerable variation exists in the relative risk of death following different AIDS defining clinical conditions.

According to the US CDC definition, you have AIDS if you are infected with HIV and present with one of the following:

A CD4+ T-cell count below 200 cells/µl (or a CD4+ T-cell percentage of total lymphocytes of less than 14%)

1987 definition

 * 1) Candidiasis of bronchi, trachea, or lungs
 * 2) Candidiasis esophageal
 * 3) Coccidioidomycosis, disseminated or extrapulmonary
 * 4) Cryptococcosis, extrapulmonary
 * 5) Cryptosporidiosis, chronic intestinal for longer than 1 month
 * 6) Cytomegalovirus disease (other than liver, spleen or lymph nodes)
 * 7) Cytomegalovirus retinitis (with loss of vision)
 * 8) Encephalopathy (HIV-related)
 * 9) Herpes simplex: chronic ulcer(s) (for more than 1 month); or bronchitis, pneumonitis, or esophagitis
 * 10) Histoplasmosis, disseminated or extrapulmonary
 * 11) Isosporiasis, chronic intestinal (for more than 1 month)
 * 12) Kaposi's sarcoma
 * 13) Lymphoma, Burkitt's
 * 14) Lymphoma, immunoblastic (or equivalent term)
 * 15) Lymphoma, primary, of brain
 * 16) Mycobacterium avium complex or Mycobacterium kansasii, disseminated or extrapulmonary
 * 17) Mycobacterium, other species, disseminated or extrapulmonary
 * 18) Mycobacterium tuberculosis, any site (extrapulmonary)
 * 19) Pneumocystis jiroveci pneumonia (formerly Pneumocystis carinii)
 * 20) Progressive multifocal leukoencephalopathy
 * 21) Salmonella septicemia (recurrent)
 * 22) Toxoplasmosis of the brain
 * 23) Tuberculosis, disseminated
 * 24) Wasting syndrome due to HIV

Added in 1993

 * 1) Cervical cancer (invasive)
 * 2) Mycobacterium tuberculosis, any site (pulmonary)
 * 3) Pneumonia (recurrent)

Children < 13 years
Additional conditions are included for children less than 13:
 * Bacterial infections, multiple or recurrent
 * Lymphoid interstitial pneumonia or pulmonary lymphoid hyperplasia complex

Historical Perspective
In 1993, the CDC added pulmonary tuberculosis, recurrent pneumonia, and invasive cervical cancer to the list of clinical conditions in the AIDS surveillance case definition published in 1987 and expanded the AIDS surveillance case definition to include all HIV-infected persons with CD4+ T-lymphocyte counts of less than 200 cells/uL or a CD4+ percentage of less than 14.

It has been suggested that other conditions (such as Penicilliosis) should be included in other countries.