8/9/2019 Who Clinical Staging of Hiv

1/14

STAGE 1STAGE 2

STAGE 3

STAGE 4

8/9/2019 Who Clinical Staging of Hiv

2/14

Moderate unexplained weightloss

(

8/9/2019 Who Clinical Staging of Hiv

3/14

Severe weightloss(>10% ofpresumedormeasured

body weight)

Unexplainedchronicdiarrhoeaforlongerthan one month

Unexplainedpersistentfever(intermittentorconstantfor

longerthan one month) Oralcandidiasis

Oralhairyleukoplakia

Pulmonarytuberculosis(TB)diagnosedin lasttwoyears

Severepresumed bacterialinfections(e.g.pneumonia,

empyema,pyomyositis, boneor jointinfection,meningitis, bacteraemia)

Acute necrotizing ulcerativestomatitis,gingivitisor

periodontitis

8/9/2019 Who Clinical Staging of Hiv

4/14

HIV wastingsyndrome

Pneumocystis pneumonia

Recurrentsevereorradiological bacterialpneumonia

Chronicherpessimplexinfection (morethan one months

duration) Oesophagealcandidiasis

Extrapulmonary TB

Kaposissarcoma

Central nervoussystem (CNS)toxoplasmosis

HIVencephalopathy

8/9/2019 Who Clinical Staging of Hiv

5/14

SEVERITY CD 4 LEVELS

Notsignificantimmunosuppression >500/cu mm

Mildimmunosuppression 350 499/cu mm

Advancedimmunosuppression 200 349/cu mm

Severeimmunosuppression

8/9/2019 Who Clinical Staging of Hiv

6/14

8/9/2019 Who Clinical Staging of Hiv

7/14

Clinicalcondition Recommendation

WHOClinical Stage 1 Start ART ifCD4 350

WHOClinical Stage 2 Start ART ifCD4 350

WHOClinical Stage 3 or4 Start ART irrespectiveofCD4

cellcount

Active TB disease Start ART irrespectiveofCD4

cellcount

HBVco-infection requiring

therapy

Start ART irrespectiveofCD4

cellcount

8/9/2019 Who Clinical Staging of Hiv

8/14

CLINICAL MONI ORING

Monitoringofadherence

Monitoringoftolerance

Monitoringof fficacy

LABORATORY MONITORING

8/9/2019 Who Clinical Staging of Hiv

9/14

Adherenceto ART isessentialand morethan95% adherenceisrequiredforeffectivenessoftherapy

Causesofany new symptomsandsigns

should beidentifiedafterinitiation ofART

8/9/2019 Who Clinical Staging of Hiv

10/14

Indicatorsforimprovementin thepatients

condition would be

Gain in body weight

Decreasein frequencyorseverityofopportunisticinfections

Increasein CD4 countof100-200 cellsperyear

(this may belessifinitialCD4

8/9/2019 Who Clinical Staging of Hiv

11/14

Full bloodcountincludingplateletcount

(patientson Zidovudine mayrequire

frequentHb monitoring) Fasting Blood Sugar(ifthepatientison

PIs)

Liverfunction tests(ALT, AST)

Renalfunction tests(Tenofovir)

8/9/2019 Who Clinical Staging of Hiv

12/14

Thefollowingtripletherapyregimensare

recommended:

2 NucleosideReverse TranscriptaseInhibitors

(NRTIs)and 1 Non-NucleosideReverse Transcriptase

Inhibitor(NNRTI)

2 NRTIsand 1 ProteaseInhibitor(PI)

8/9/2019 Who Clinical Staging of Hiv

13/14

Zidovudine+Lamivudine+Nevirapine

(Stavudine +Lamivudine+Nevirapine)

(Zidovudine+Lamivudine+Efavirenz )

Abacavir + Tenofovir +LopinavirDidanosine + Abacavir +Nelfinavir

8/9/2019 Who Clinical Staging of Hiv

14/14