Article

Revised Surveillance Case Definition for HIV Infection - United States, 2014

ABSTRACT

Following extensive consultation and peer review, CDC and the Council of State and Territorial Epidemiologists have revised and combined the surveillance case definitions for human immunodeficiency virus (HIV) infection into a single case definition for persons of all ages (i.e., adults and adolescents aged ≥13 years and children aged <13 years). The revisions were made to address multiple issues, the most important of which was the need to adapt to recent changes in diagnostic criteria. Laboratory criteria for defining a confirmed case now accommodate new multitest algorithms, including criteria for differentiating between HIV-1 and HIV-2 infection and for recognizing early HIV infection. A confirmed case can be classified in one of five HIV infection stages (0, 1, 2, 3, or unknown); early infection, recognized by a negative HIV test within 6 months of HIV diagnosis, is classified as stage 0, and acquired immunodeficiency syndrome (AIDS) is classified as stage 3. Criteria for stage 3 have been simplified by eliminating the need to differentiate between definitive and presumptive diagnoses of opportunistic illnesses. Clinical (nonlaboratory) criteria for defining a case for surveillance purposes have been made more practical by eliminating the requirement for information about laboratory tests. The surveillance case definition is intended primarily for monitoring the HIV infection burden and planning for prevention and care on a population level, not as a basis for clinical decisions for individual patients. CDC and the Council of State and Territorial Epidemiologists recommend that all states and territories conduct case surveillance of HIV infection using this revised surveillance case definition.

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Available from: Bernard Branson, Apr 16, 2014
Recommendations and Reports / Vol. 63 / No. 3 April 11, 2014
Revised Surveillance Case Definition
for HIV Infection — United States, 2014
U.S. Department of Health and Human Services
Centers for Disease Control and Prevention
Morbidity and Mortality Weekly Report
Page 1
Recommendations and Reports
The MMWR series of publications is published by the Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention (CDC),
U.S. Department of Health and Human Services, Atlanta, GA 30333.
Suggested citation: [Author names; first three, then et al., if more than six.] [Title]. MMWR 2014;63(No. RR-#):[inclusive page numbers].
Centers for Disease Control and Prevention
Thomas R. Frieden, MD, MPH, Director
Harold W. Jaffe, MD, MA, Associate Director for Science
Joanne Cono, MD, ScM, Director, Office of Science Quality
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Michael F. Iademarco, MD, MPH, Director, Center for Surveillance, Epidemiology, and Laboratory Services
MMWR Editorial and Production Staff (Serials)
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Matthew L. Boulton, MD, MPH, Ann Arbor, MI
Virginia A. Caine, MD, Indianapolis, IN
Barbara A. Ellis, PhD, MS, Atlanta, GA
Jonathan E. Fielding, MD, MPH, MBA, Los Angeles, CA
David W. Fleming, MD, Seattle, WA
William E. Halperin, MD, DrPH, MPH, Newark, NJ
King K. Holmes, MD, PhD, Seattle, WA
Timothy F. Jones, MD, Nashville, TN
Rima F. Khabbaz, MD, Atlanta, GA
Dennis G. Maki, MD, Madison, WI
Patricia Quinlisk, MD, MPH, Des Moines, IA
Patrick L. Remington, MD, MPH, Madison, WI
William Schaffner, MD, Nashville, TN
CONTENTS
Introduction ............................................................................................................1
Methods
....................................................................................................................3
Revised Surveillance Case Definition
............................................................. 3
References
................................................................................................................7
Appendix: Stage-3-Defining Opportunistic Illnesses
in HIV Infection
................................................................................................ 10
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MMWR / April 11, 2014 / Vol. 63 / No. 3 1
Introduction
Since the first cases of acquired immunodeficiency syndrome
(AIDS) were reported in the United States in 1981, surveillance
case definitions for human immunodeficiency virus (HIV)
infection (the cause of AIDS) and AIDS have undergone
several revisions to respond to diagnostic advances (1–5).
This document updates the surveillance case definitions
published in 2008 (5). It addresses multiple issues, the
most important of which was the need to adapt to recent
changes in diagnostic criteria. Other needs that prompted
the revision included 1) recognition of early HIV infection,
2) differentiation between HIV-1 and HIV-2 infections,
3) consolidation of staging systems for adults/adolescents and
children, 4) simplification of criteria for opportunistic illnesses
indicative of AIDS, and 5) revision of criteria for reporting
diagnoses without laboratory evidence.
Summary of Revisions to
Surveillance Case Definition
The most important update is revision of the laboratory
criteria for a confirmed case, which addresses the development
of new diagnostic testing algorithms that do not use the
Western blot or immunofluorescence HIV antibody assays.
During 2009–2011, CDC and the Association of Public
Health Laboratories proposed new diagnostic algorithms
(6,7), and in June 2011 the Clinical and Laboratory
Standards Institute (CLSI) published updated laboratory
testing procedures for diagnosis of HIV infection (8). In
these multitest algorithms, “supplemental” HIV tests (for
confirming or verifying the presence of HIV infection after a
positive [or “reactive”] result from an initial HIV test) can now
include antibody immunoassays formerly used only as initial
tests (e.g., conventional immunoassays or rapid tests) or can
include nucleic acid tests (NAT). The 2008 surveillance case
definition was not clearly consistent with the new algorithms
because it specified that a test used for confirmation must be a
supplemental HIV antibody test (e.g., Western blot or indirect
Corresponding author: Richard M. Selik, MD, Division of HIV/AIDS
Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and
TB Prevention, CDC. Telephone: 404-639-4495; E-mail: rms1@cdc.gov.
Revised Surveillance Case Definition for HIV Infection —
United States, 2014
Prepared by
Richard M. Selik, MD
1
Eve D. Mokotoff, MPH
2
Bernard Branson, MD
1
S. Michele Owen, PhD
1
Suzanne Whitmore, DrPH
1
H. Irene Hall, PhD
1
1
Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC
2
HIV/STD/VH/TB Epidemiology Section, Michigan Department of Community Health
Summary
Following extensive consultation and peer review, CDC and the Council of State and Territorial Epidemiologists have revised
and combined the surveillance case definitions for human immunodeficiency virus (HIV) infection into a single case definition for
persons of all ages (i.e., adults and adolescents aged ≥13 years and children aged <13 years). The revisions were made to address
multiple issues, the most important of which was the need to adapt to recent changes in diagnostic criteria. Laboratory criteria for
defining a confirmed case now accommodate new multitest algorithms, including criteria for differentiating between HIV-1 and
HIV-2 infection and for recognizing early HIV infection. A confirmed case can be classified in one of five HIV infection stages
(0, 1, 2, 3, or unknown); early infection, recognized by a negative HIV test within 6 months of HIV diagnosis, is classified as stage 0,
and acquired immunodeficiency syndrome (AIDS) is classified as stage 3. Criteria for stage 3 have been simplified by eliminating
the need to differentiate between definitive and presumptive diagnoses of opportunistic illnesses. Clinical (nonlaboratory) criteria
for defining a case for surveillance purposes have been made more practical by eliminating the requirement for information about
laboratory tests. The surveillance case definition is intended primarily for monitoring the HIV infection burden and planning for
prevention and care on a population level, not as a basis for clinical decisions for individual patients. CDC and the Council of
State and Territorial Epidemiologists recommend that all states and territories conduct case surveillance of HIV infection using
this revised surveillance case definition.
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2 MMWR / April 11, 2014 / Vol. 63 / No. 3
immunofluorescence assay test)” (5). This revised surveillance
case definition explicitly allows these new testing algorithms.
Some new multitest algorithms lead to a conclusion that
laboratories might classify as a “presumptive positive” result.
Persons with a presumptive positive test result are expected to
receive subsequent tests, such as a quantitative viral load, to
confirm their HIV diagnosis, but results of those tests might
not be immediately available to surveillance programs. To
avoid unnecessary complexity for surveillance, the revised
surveillance case definition, like the earlier definition, does
not make a distinction between presumptive and definitive
diagnoses. If subsequent test results reveal that the person is
not infected, the case and previous test results should be deleted
from the surveillance database.
Another important change is the addition of “stage 0” based
on a sequence of negative and positive test results indicative
of early HIV infection. This addition takes advantage of tests
incorporated in the new algorithms that are more sensitive
during early infection than previously used tests, and that
together with a less sensitive antibody test, yield a combination
of positive and negative results enabling diagnosis of acute
(primary) HIV infection, which occurs before the antibody
response has fully developed. The addition of stage 0 allows
for routine monitoring of the number of cases diagnosed
within several months after infection, which includes the
most highly infectious period when viral loads are extremely
high and intervention might be most effective in preventing
further transmission. The definition of stage 0 also will reduce
confusion between acute HIV infection (part of stage 0), when
CD4+ T-lymphocyte counts can be transiently depressed,
and stage 3 (AIDS), an advanced stage of HIV infection
when CD4+ T-lymphocyte values are usually persistently
depressed (9).
The revised case definition adds other criteria and eliminates
several criteria that were impractical or difficult to implement
uniformly across all states and territories. Specifically, the
revised case definition:
• Adds specific criteria for defining a case of HIV-2, which
were not included in the 2008 case definition. The new
definition incorporates criteria for HIV-2 infection used
in a report of surveillance for HIV-2 infection (10) and
included in one of the new CLSI testing algorithms (8).
• Eliminates the requirement to indicate if opportunistic
illnesses (AIDS-defining conditions) indicative of stage 3
(AIDS) were diagnosed by “definitive” or “presumptive
methods. This requirement has been impractical to
implement because the criteria to distinguish between
definitive” and “presumptive” methods were not
interpreted in a standard, uniform way by state and local
surveillance programs.
• Classifies stages 1–3 of HIV infection on the basis of the
CD4+ T-lymphocyte count unless persons have had a
stage-3–defining opportunistic illness. The CD4+
T-lymphocyte percentage is used only when the
corresponding CD4+ T-lymphocyte count is unknown.
This avoids overestimating the proportion of cases in
stage 3, which occured when the stage was based on
whichever CD4+ T-lymphocyte test result (count or
percentage) indicated the more advanced stage. Clinical
evidence suggests the percentage has little effect on
prognosis after adjusting for the count (11,12).
• Removes the requirement that a “physician-documented”
diagnosis must be based on laboratory evidence. This
revision allows clinical evidence to be sufficient to define
a case when it is impractical to retrieve laboratory test
information regarding the initial diagnosis. The new
definition also clarifies that the date of a physician-
documented diagnosis is the diagnosis date recorded in a
medical record note, rather than the date that the physician
wrote the note.
• Combines the adult and pediatric criteria for a confirmed
case of HIV infection and specifies different criteria for
staging HIV infection among three age groups (<1 year,
1–5 years, and ≥6 years).
• Eliminates the distinction between definitive and
presumptive diagnoses of HIV infection in children aged
<18 months.
• Removes lymphoid interstitial pneumonia (pulmonary
lymphoid hyperplasia) from the list of opportunistic
illnesses indicative of stage 3 in children because this illness
is associated with moderate rather than severe
immunodeficiency (4).
• Eliminates the requirement that evidence of HIV infection
in a child’s biologic mother is needed to define a case of
HIV infection in a child aged <18 months when laboratory
testing of the infant independently confirms HIV
infection. This change was recommended in a position
statement approved at the June 2009 annual meeting of
the Council of State and Territorial Epidemiologists
(CSTE) (13).
• Extends the use of CD4+ T-lymphocyte counts and
percentages for determining the stage of HIV infection to
children as well as adults and adolescents, and now
determines the stage in children aged 6–12 years the same
way as in adults and adolescents. In the 2008 case
definition, only the presence or absence of opportunistic
illnesses was used as criteria for staging cases among
children aged <13 years.
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MMWR / April 11, 2014 / Vol. 63 / No. 3 3
Scope and Applicability of the
Surveillance Case Definition
This revised case definition, like the earlier one, is intended
primarily for public health surveillance of HIV infection
on a population level. Early diagnosis and viral suppression
facilitate prevention of HIV transmission, morbidity, and
mortality. This case definitions staging system allows for
health departments to evaluate prevention and care, which
can be measured by analyzing cases by their stage at diagnosis
and how rapidly they progress to more advanced stages. For
various reasons, it would be inappropriate for clinicians to use
the surveillance staging system as a guide to manage patients.
United States national panels on antiretroviral guidelines
recommend antiretroviral therapy for all HIV-infected adults,
adolescents, and infants, and the staging system does not
include criteria strongly recommended as indicators for more
rapid initiation of therapy (e.g., HIV nephropathy, hepatitis B
coinfection, viral load >100,000 copies/mL, and a decline in
CD4+ T-lymphocyte count by >100 cells/µL per year) (1416).
Treatment guidelines for children aged >1 year also recommend
starting therapy on the basis of criteria other than stage, such
as a viral load >100,000 copies/mL or conditions that are
important (e.g., clinical category B [13]) but do not indicate
stage 3, if treatment had been deferred after diagnosis (16,17).
Methods
The revised case definition was developed in several stages.
First, in 2010, HIV surveillance experts at CDC convened six
work groups that included both CDC and external subject
matter experts, including health-care providers, surveillance
health department staff, and representatives from academic
institutions and public health and commercial laboratories.
The names of work group members are listed at the end of this
report. The six topic areas were new HIV testing algorithms,
acute HIV infection, HIV-2 infection, opportunistic illnesses,
pediatric HIV infection, and physician-documented diagnosis.
Each work group examined research and program information
about the topic areas and elicited experience and expert opinion
from federal, state, and local HIV surveillance programs;
clinicians who diagnose HIV infection; and laboratories that
report HIV test results.
Second, all work groups presented a summary of their reports
at a consultation convened by CDC in February 2012. The
consultation included additional experts in HIV surveillance,
laboratory testing, and clinical care, including members
of CSTE.
Third, most of the recommendations from the consultation were
incorporated in a position statement developed in collaboration
with CDC that was approved at the June 2012 annual meeting of
CSTE (18). The revisions of the surveillance case definition in this
document are based largely on that position statement. Finally,
this document underwent peer review (described at http://www.
cdc.gov/hiv/pdf/policies_PRP_Revised_HIV_Case_Def.pdf)
by health-care professionals in compliance with the Office of
Management and Budget requirements for the dissemination
of influential scientific information.
Revised Surveillance Case Definition
Section 1: Criteria for a Confirmed Case
Criteria for a confirmed case can be met by either laboratory
evidence or clinical evidence, as described below. Laboratory
evidence is preferred over clinical evidence.
1.1: Persons Aged 18 Months and Children Aged
<18 Months whose Mothers were Not Infected
1.1.1: Laboratory Evidence
Laboratory criteria require reporting of the date of the
specimen collection for positive test results in multitest
algorithms or stand-alone virologic tests and enough
information about the tests to determine that they meet any
of the following criteria:
• A multitest algorithm consisting of
A positive (reactive) result from an initial HIV antibody
or combination antigen/antibody test, and
An accompanying or subsequent positive result from
a supplemental HIV test different from the initial
test (8).
The initial HIV antibody or antigen/antibody test
and the supplemental HIV test that is used to verify the
result from the initial test can be of any type used as an
aid to diagnose HIV infection. For surveillance purposes,
supplemental tests can include some not approved by the
Food and Drug Administration (FDA) for diagnosis (e.g.,
HIV-1 viral load test, HIV-2 Western blot/immunoblot
antibody test, and HIV-2 NAT). However, the initial
and supplemental tests must be “orthogonal” (i.e., have
different antigenic constituents or use different principles)
to minimize the possibility of concurrent nonspecific
reactivity. Because the antigenic constituents and test
principles are proprietary information that might not be
publicly available for some tests, tests will be assumed to
be orthogonal if they are of different types. For example:
One test is a combination antigen/antibody test and
the other an antibody-only test.
One test is an antibody test and the other a NAT.
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One test is a rapid immunoassay (a single-use analytical
device that produces results in <30 minutes) and the
other a conventional immunoassay.
One test is able to differentiate between HIV-1 and
HIV-2 antibodies and the other is not.
Tests also will be assumed to be orthogonal if they are
of the same type (e.g., two conventional immunoassays)
but made by different manufacturers. The type of HIV
antibody test that verifies the initial test might be one
formerly used only as an initial test (e.g., conventional
or rapid immunoassay, HIV-1/2 type-differentiating
immunoassay), or it might be one traditionally used as
a supplemental test for confirmation (e.g., Western blot,
immunofluorescence assay).
• A positive result of a multitest HIV antibody algorithm from
which only the final result was reported, including a single
positive result on a test used only as a supplemental test (e.g.,
HIV Western blot, immunofluorescence assay) or on a test
that might be used as either an initial test or a supplemental
test (e.g., HIV-1/2 type-differentiating rapid antibody
immunoassay) when it might reasonably be assumed to have
been used as a supplemental test (e.g., because the algorithm
customarily used by the reporting laboratory is known).
• A positive result or report of a detectable quantity (i.e.,
within the established limits of the laboratory test) from
any of the following HIV virologic (i.e., nonantibody) tests:
Qualitative HIV NAT (DNA or RNA)
Quantitative HIV NAT (viral load assay)
HIV-1 p24 antigen test
HIV isolation (viral culture) or
HIV nucleotide sequence (genotype).
1.1.2: Clinical (Nonlaboratory) Evidence
Clinical criteria for a confirmed case (i.e., a “physician-
documented” diagnosis for which the surveillance staff have
not found sufficient laboratory evidence described above) are
met by the combination of:
• A note in a medical record by a physician or other qualified
medical-care provider that states that the patient has HIV
infection, and
• One or both of the following:
The laboratory criteria for a case were met based on
tests done after the physicians note was written
(validating the note retrospectively).
Presumptive evidence of HIV infection (e.g., receipt of
HIV antiretroviral therapy or prophylaxis for an
opportunistic infection), an otherwise unexplained low
CD4+ T-lymphocyte count, or an otherwise unexplained
diagnosis of an opportunistic illness (Appendix).
1.2: Children Aged <18 Months Born to Mothers
Who Have an Unknown Infection Status or Were
Known to be Infected
1.2.1: Laboratory Evidence
A child aged <18 months is categorized for surveillance
purposes as HIV infected if all of the following criteria are met:
• Positive results on at least one specimen (not including
cord blood) from any of following HIV virologic tests:
HIV-1 NAT (DNA or RNA)
HIV-1 p24 antigen test, including neutralization assay
for a child aged >1 month
HIV isolation (viral culture) or
HIV nucleotide sequence (genotype).
• The test date (at least the month and year) is known.
• One or both of the following:
Confirmation of the first positive result by another
positive result on one of the above virologic tests from
a specimen obtained on a different date or
No subsequent negative result on an HIV antibody
test, and no subsequent negative result on an HIV NAT
before age 18 months.
1.2.2: Clinical Evidence
• The same criteria as in section 1.1.2 or
• All three of the following alternative criteria:
Evidence of perinatal exposure to HIV infection before
age 18 months
ˏ A mother with documented HIV infection or
ˏ A confirmed positive test for HIV antibody (e.g.,
a positive initial antibody test or antigen/antibody
test, confirmed by a supplemental antibody test) and
a mother whose infection status is unknown or
undocumented.
Diagnosis of an opportunistic illness indicative of
stage 3 (Appendix).
No subsequent negative result on an HIV antibody test.
1.3: Definition for Date of Diagnosis of a
Confirmed Case for all Ages
1.3.1: Laboratory Criteria
If the diagnosis is based on laboratory evidence, the diagnosis
date is defined as the earliest date on which the specimen was
obtained for a positive HIV test result.
1.3.2: Clinical Criteria
If the diagnosis was based on clinical evidence (“physician-
documented”) rather than laboratory evidence, the diagnosis
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MMWR / April 11, 2014 / Vol. 63 / No. 3 5
date is defined as the date (at least the year) of diagnosis
reported in the content of the medical record. If the diagnosis
date was not reported in the note, the date when the note was
written can be used as a proxy.
Section 2: Criteria for Classifying the
HIV Type as HIV-2
All HIV infections in the United States should be assumed
to be type 1 (HIV-1) unless laboratory test results are sufficient
to classify the infection as type 2 (HIV-2), dual HIV-1 and
HIV-2 infections, or undifferentiated HIV infection, as
described below. Clinical or epidemiologic evidence might
lead to laboratory testing for HIV-2 but is insufficient for
classifying the HIV type as HIV-2.
2.1: Persons Aged 18 Months and Children Aged
<18 Months Not Perinatally Exposed
HIV-2 infection
For HIV-2 infection, one or more of the following laboratory
criteria are necessary and sufficient:
• FDA-approved HIV1/2 type-differentiating antibody test
result positive for HIV-2 and negative for HIV-1.
• Positive HIV-2 Western blot (WB) (or immunoblot or line
assay) result and negative or indeterminate HIV-1 WB result.
• Positive qualitative HIV-2 NAT result.
• Detectable quantitative HIV-2 NAT (viral load).
• Laboratory results interpreted as consistent with HIV-2
infection by a laboratory expert experienced in
differentiating HIV-2 from HIV-1 if laboratory evidence
for HIV-2 is ambiguous.
Dual infection with HIV-1 and HIV-2
The HIV type is classified as “dual” infection (both HIV-1
and HIV-2) if both an HIV-1 NAT and an HIV-2 NAT
are positive.
Undifferentiated HIV type
The HIV type is classified as “undifferentiated” if there
is no positive or detectable result from an HIV-1 NAT and
a laboratory expert cannot resolve ambiguous evidence for
HIV-2, such as:
• HIV-2 WB is positive and HIV-1 WB is HIV positive or
• HIV-1/HIV-2 type-differentiating antibody test result
interpretation is “undifferentiated” (positive for both
HIV-1 and HIV-2).
2.2: Difficulty of Diagnosing HIV-2 Infection in
Children Aged <18 Months Born to Mothers
Known to be HIV-infected or whose HIV Infection
Status is Unknown
In perinatally exposed children aged <18 months, antibody
tests are not used to diagnose HIV infection because of the
expectation that they might be false indicators of infection in the
child due to passive transfer of maternal antibody. The HIV-1
NAT routinely used to diagnose HIV-1 infection in children
of this age is likely to be negative in an HIV-2-infected child
because it is insensitive to HIV-2. A positive HIV-2 NAT result
would satisfy the criteria for a case. Otherwise, the diagnosis of
HIV-2 infection in a child will need to wait until the child is
aged 18 months, when it can be based on antibody test results.
Section 3: Criteria for Uninfected and
Indeterminate HIV Infection Status of
Perinatally Exposed Children
Aged <18 Months
3.1: Uninfected
A child aged <18 months who was born to an HIV-infected
mother or had a positive HIV antibody test result is classified
for surveillance purposes as not infected with HIV if all three
of the following criteria are met:
• Laboratory criteria for HIV infection are not met (see
section 1.2.1)
• No diagnosis of a stage-3-defining opportunistic illness
(Appendix) attributed to HIV infection and
• Either laboratory or clinical evidence of absence of
HIV infection as described below.
3.1.1: Laboratory Evidence
Definitively Uninfected
• No positive HIV NAT (RNA or DNA) and
• At least one of the following criteria:
At least two negative HIV NATs from specimens
obtained on different dates, both of which were at age
≥1 month and one of which was at age ≥4 months.
At least two negative HIV antibody tests from
specimens obtained on different dates at age ≥6 months.
Presumptively Uninfected
• Criteria for definitively uninfected with HIV are not met
• At least one of the following four laboratory criteria are met:
At least two negative NATs from specimens obtained
on different dates, both of which were at age ≥2
weeks and one of which was at age ≥4 weeks.
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6 MMWR / April 11, 2014 / Vol. 63 / No. 3
One negative NAT (RNA or DNA) from a specimen
obtained at age ≥8 weeks.
One negative HIV antibody test from a specimen
obtained at age ≥6 months.
If criteria for HIV infection had initially been met by
one positive HIV NAT test then it must have been
followed by at least two negative test results from
specimens obtained on different dates, one of which is:
ˏ A NAT test from a specimen obtained at age ≥8 weeks,
or
ˏ An HIV antibody test from a specimen obtained at
age ≥6 months.
and
• No subsequent positive NAT.
3.1.2: Clinical Evidence
A note in a medical record by a physician or other qualified
medical-care provider states that the patient is not infected
with HIV.
3.2: Indeterminate HIV infection status
A child aged <18 months born to an HIV-infected mother is
categorized as having perinatal exposure with an indeterminate
HIV infection status if neither the criteria for being HIV-
infected nor the criteria for being uninfected are met.
Section 4: Criteria for Classifying the
Stage of HIV Infection
The stages of HIV infection defined in this document are for
surveillance staging of disease and might not be appropriate for
patient care, clinical research, or other purposes. A confirmed
case that meets the criteria for diagnosis of HIV infection can
be classified in one of five HIV infection stages (0, 1, 2, 3, or
unknown). Stage 0 indicates early HIV infection, inferred from
a negative or indeterminate HIV test result within 6 months
of a confirmed positive result, and these criteria supersede and
are independent of the criteria used for later stages. Stages 1,
2, and 3 are based on the CD4+ T-lymphocyte count. If the
CD4+ count is missing or unknown, the CD4+ T-lymphocyte
percentage of total lymphocytes can be used to assign the stage.
Cases with no information on CD4+ T-lymphocyte count or
percentage are classified as stage unknown. If a stage-3–defining
opportunistic illness has been diagnosed, then the stage is 3
regardless of CD4 T-lymphocyte test results, unless the criteria
described below for stage 0 are met. CD4+ T-lymphocyte counts
or percentages at the time of diagnosis allow classification of cases
by stage at diagnosis. Subsequent CD4+ T-lymphocyte counts
or percentages help monitor disease progression and whether
the person is receiving on-going care.
The stage characterizes the status of HIV disease at a
particular point in time. Of primary interest to surveillance is
the stage at initial diagnosis, but the stage can change in either
direction after diagnosis and might be defined with reference
to dates of interest such as the most advanced stage recorded
through a particular date. The stages are defined as follows:
Stage 0
The criteria for stage 0 consist of a sequence of discordant test
results indicative of early HIV infection in which a negative or
indeterminate result was within 180 days of a positive result.
The criteria for stage 0 supersede and are independent of the
criteria used for other stages.
Stage 0 can be established either:
• Based on testing history (previous negative/indeterminate
test results): a negative or indeterminate HIV test
(antibody, combination antigen/antibody, or nucleic acid
test) result within 180 days before the first confirmed
positive HIV test result of any type. The first positive test
result could be any time before the positive supplemental
test result that confirms it or
• Based on a testing algorithm: a sequence of tests performed
as part of a laboratory testing algorithm that demonstrate
the presence of HIV-specific viral markers such as
p24 antigen or nucleic acid (RNA or DNA) 0–180 days
before or after an antibody test that had a negative or
indeterminate result. Examples of algorithms that would
fulfill this requirement include:
A positive initial HIV immunoassay result (e.g.,
antigen/antibody or antibody only) followed by a
negative or indeterminate supplemental antibody test
result (e.g., HIV-1/HIV-2 antibody differentiation
assay or Western blot) and a positive NAT result. All
three tests are usually performed as part of the same
testing algorithm but time might elapse between tests
if additional specimens must be obtained for definitive
supplemental testing.
A negative initial HIV immunoassay result followed by
a positive NAT result that might have been done to
evaluate the presence of acute HIV infection (19,20).
Exception
A confirmed case of HIV infection is not in stage 0 if the
negative or indeterminate HIV test used as the criterion for it
being a recent infection was preceded >60 days by evidence of HIV
infection, such as a confirmed positive HIV test result, a clinical
(physician-documented) diagnosis of HIV infection for which the
surveillance staff have not found sufficient laboratory evidence,
a CD4+ T-lymphocyte test result indicative of stage 3 (Table), or
an opportunistic illness indicative of stage 3 (Appendix).
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MMWR / April 11, 2014 / Vol. 63 / No. 3 7
Classifying a case as stage 0 depends on documenting
negative HIV antibody test results in the specific situations
described above. Negative test results from testing algorithms
that have concluded that the person is not infected need not
be reported to HIV surveillance programs.
Progression of Stage After Initial Diagnosis in
Stage 0
Although the stage at diagnosis does not change, if >180
days have elapsed after the stage was 0 at diagnosis, the stage
at the later date is classified as 1, 2, 3, or unknown, depending
on CD4+ T-lymphocyte test results (Table) or whether an
opportunistic illness had been diagnosed >180 days after HIV
infection diagnosis.
Stages 1, 2, 3, and unknown
If the criteria for stage 0 are not met, the stage is classified
as 1, 2, 3, or unknown, depending on CD4+ T-lymphocyte
test results or whether an opportunistic illness was diagnosed
(Table). Infection among children aged 6–12 years is
staged with the same criteria as infection among adults and
adolescents, including opportunistic illnesses indicative of
stage 3 (Appendix) that formerly applied only to adults and
adolescents (i.e., pulmonary tuberculosis, recurrent pneumonia,
and cervical cancer). Multiple or recurrent bacterial infections
(other than recurrent salmonella septicemia), which formerly
applied only to children aged <13 years, now apply only to
children aged <6 years. Lymphoid interstitial pneumonia is no
longer classified as indicative of stage 3 in children because it is
associated with moderate rather than severe immunodeficiency
(4). The diagnosis of any of the opportunistic illnesses,
irrespective of diagnostic method used, will meet the criteria
for staging, thereby eliminating the requirement in the 2008
case definition for some of them to be “definitively” diagnosed.
References
1. CDC. Revision of the case definition of acquired immunodeficiency
syndrome for national reporting—United States. MMWR 1985;34:373–5.
2. CDC. Revision of the CDC surveillance case definition for acquired
immunodeficiency syndrome. MMWR 1987;36(Suppl No. 1S).
3. CDC. 1993 revised classification system for HIV infection and expanded
surveillance case definition for AIDS among adolescents and adults.
MMWR 1992;41(No. RR-17).
4. CDC. 1994 Revised classification system for human immunodeficiency
virus infection in children less than 13 years of age. MMWR 1994;
43(No. RR-12).
5. CDC. Revised surveillance case definitions for HIV infection among
adults, adolescents, and children aged <18 Months and for HIV infection
and AIDS among children aged 18 months to <13 years. MMWR
2008;57(No. RR-10).
6. Branson BM. The future of HIV testing. J Acquir Immune Defic Syndr
2010;55:Suppl 2:S102–5.
7. Branson BM, Mermin J, Establishing the diagnosis of HIV infection:
new tests and a new algorithm for the United States. J Clin Virol 2011;52
Suppl 1:S3–4.
8. Clinical and Laboratory Standards Institute. Criteria for laboratory
testing and diagnosis of human immunodeficiency virus infection;
approved guideline. CLSI document M53-A. Wayne, PA: Clinical and
Laboratory Standards Institute; 2011:1–60.
9. Tindall B, Hing M, Edwards P, Barnes T, Mackie A, Cooper DA. Severe
clinical manifestations of primary HIV infection. AIDS 1989;3:747–9.
10. CDC. HIV-2 Infection surveillance—United States, 1987-2009.
MMWR 2011;60:985-8. Available at http://www.cdc.gov/mmwr/
preview/mmwrhtml/mm6029a3.htm?s_cid=mm6029a3_e%0d%0a.
11. Gebo KA, Gallant JE, Keruly JC, Moore RD. Absolute CD4 vs.CD4
percentage for predicting the risk of opportunistic illness in HIV
infection. J Acquir Immun Defic Syndr 2004;36:1028–33.
12. Boyd K, Dunn DT, Castro H, et al. HIV Paediatric Prognostic Markers
Collaborative Study. Discordance between CD4 cell count and CD4
cell percentage: implications for when to start antiretroviral therapy in
HIV-1 infected children. AIDS 2010, 24:1213–17.
13. Council of State and Territorial Epidemiologists. CSTE Position
Statement 09-ID-01:7. Available at http://c.ymcdn.com/sites/www.cste.
org/resource/resmgr/PS/09-ID-01.pdf.
14. Thompson MA, Aberg JA, Hoy JF, et al. Antiretroviral treatment of adult
HIV infection: 2012 recommendations of the International Antiviral
Society–USA Panel. JAMA 2012;308:387–402.
15. Panel on Antiretroviral Guidelines for Adults and Adolescents.
Guidelines for the use of antiretroviral agents in HIV-1-infected
adults and adolescents. Department of Health and Human Services.
Section on initiating antiretroviral therapy in treatment-naive
patients:E-10. Available at http://aidsinfo.nih.gov/contentfiles/
lvguidelines/AdultandAdolescentGL.pdf.
16. Panel on Antiretroviral Therapy and Medical Management of HIV-
Infected Children. Guidelines for the Use of Antiretroviral Agents in
Pediatric HIV Infection [November 5, 2012]. Indications for initiation of
antiretroviral therapy in HIV-infected children: F-7. Available at http://
aidsinfo.nih.gov/contentfiles/lvguidelines/PediatricGuidelines.pdf.
17. PENTA Steering Committee. PENTA 2009 guidelines for the use of
antiretroviral therapy in paediatric HIV-1 infection. HIV Medicine
2009;10:591–613.
18. Council of State and Territorial Epidemiologists. CSTE Position
Statement 12-ID-05. Available at http://c.ymcdn.com/sites/www.cste.
org/resource/resmgr/PS/12-ID-05FINAL.pdf.
19. Shepard CW, Gallagher K, Bodach SD, et al. Acute HIV infection—New
York City, 2008. MMWR 2009;58:1296–9.
20. Pilcher CD, Fiscus SA, Nguyen TQ, et al. Detection of acute infections
during HIV testing in North Carolina. N Engl J Med 2005;352:1873–83.
TABLE. HIV infection stage* based on age-specific CD4+ T-lymphocyte
count or CD4+ T-lymphocyte percentage of total lymphocytes
Stage
Age on date of CD4+ T-lymphocyte test
<1 yr 1–5 yrs ≥6 yrs
Cells/µL % Cells/µL % Cells/µL %
1 ≥1,500 ≥34 ≥1,000 ≥30 ≥500 ≥26
2 750–1,499 26–33 500–999 22–29 200–499 14–25
3 <750 <26 <500 <22 <200 <14
* The stage is based primarily on the CD4+ T-lymphocyte count; the CD4+
T-lymphocyte count takes precedence over the CD4 T-lymphocyte percentage,
and the percentage is considered only if the count is missing. There are three
situations in which the stage is not based on this table: 1) if the criteria for
stage 0 are met, the stage is 0 regardless of criteria for other stages (CD4
T-lymphocyte test results and opportunistic illness diagnoses); 2) if the criteria
for stage 0 are not met and a stage-3-defining opportunistic illness has been
diagnosed (Appendix), then the stage is 3 regardless of CD4 T-lymphocyte test
results; or 3) if the criteria for stage 0 are not met and information on the above
criteria for other stages is missing, then the stage is classified as unknown.
Page 9
Recommendations and Reports
8 MMWR / April 11, 2014 / Vol. 63 / No. 3
Consultation Participants and Work Group Members
CDC Consultation on Revision of the HIV Surveillance Case Definition, February 2012
External Consultants: Monica Alonso, MD, Pan American Health Organization, Washington, DC; Bridget Anderson, PhD, New York State Department
of Health, Albany, New York; John Barnhart, MPH, North Carolina Division of Public Health, Raleigh, North Carolina; Nanette Benbow, MAS, Chicago
Department of Public Health, Chicago, Illinois; Kathleen Brady, MD, Philadelphia Department of Public Health, Philadelphia, Pennsylvania; Rana
Chakraborty, MD, Emory University School of Medicine, Atlanta, Georgia; Robert Coombs, MD, University of Washington, Harborview Medical Center,
Seattle, Washington; Maria Courogen, MPH, Washington State Department of Health, Olympia, Washington; Carlos Del Rio, MD, Rollins School of Public
Health, Emory University, Atlanta, Georgia; Rebecca T. Filipowicz, MPH, Texas Department of State Health Services, Austin, Texas; Colin Flynn, ScM,
Maryland Department of Health and Mental Hygiene, Baltimore, Maryland; Douglas M. Frye, MD, Los Angeles County Department of Public Health, Los
Angeles, California; Kelly A. Gebo, MD, Johns Hopkins University School of Medicine, Baltimore, Maryland; Jane Getchell, DrPH, Association of Public
Health Laboratories, Silver Spring, Maryland; J. Jerry Gibson, MD, South Carolina Department of Health and Environmental Control, Columbia, South
Carolina; Angelique B. Griffin, MS, District of Columbia Department of Health, Washington, DC; Rebecca Grigg, PhD, Florida Department of Health,
Tallahassee, Florida; Jessica Halverson, MPH, Public Health Agency of Canada, Ottawa, Ontario; Jerry Harms, MPH, Iowa Department of Public Health,
Des Moines, Iowa; Jim Kent, MS, Public Health-Seattle & King County, Seattle, Washington; Rod Lambert, MPH, Georgia Department of Community
Health, Atlanta, Georgia; Rodger D. MacArthur, MD, Wayne State University, School of Medicine, Detroit, Michigan; William A. Meyer III, PhD, Quest
Diagnostics, Baltimore, Maryland; Eve Mokotoff, MPH, Michigan Department of Community Health, Detroit, Michigan; Godwin Obiri, DrPH, Pennsylvania
Department of Health, Harrisburg, Pennsylvania; Emily Outten, Delaware Public Health Laboratory, Smyrna, Delaware; Mark Pandori, PhD, San Francisco
Department of Public Health Laboratory, San Francisco, California; Maree Kay Parisi, San Francisco Department of Public Health, San Francisco, California;
Monica M. Parker, PhD, Wadsworth Center, New York State Department of Health, Albany, New York; Sindy Paul, MD, New Jersey Department of
Health & Senior Services, Trenton, New Jersey; Sheila Peel, PhD, Walter Reed Army Institute of Research, Rockville, Maryland; Christopher Pilcher, MD,
UCSF School of Medicine, San Francisco General Hospital, San Francisco, California; Sandy Schwarcz, MD, University of California at San Francisco, San
Francisco, California; Steven Starr, California Department of Health, Sacramento, California; Lucia V. Torian, PhD, New York City Department of Health
and Mental Hygiene, New York, New York; Barbara Werner, PhD, Massachusetts Department of Public Health, Boston, Massachusetts; Marcia Wolverton,
MPH, Houston Department of Health and Human Services, Houston, Texas.
CDC Staff Members: Bernard Branson, MD; John T. Brooks, MD; Hollie Clark, MPH; Kenneth Dominguez, MD; Steven Ethridge, MT; Kristen Mahle Gray,
MPH; H. Irene Hall, PhD; James Heffelfinger, MD; M. Patricia Joyce, MD; Steven McDougal, MD; Roque Miramontes, MPH; Janet K. Nicholson, MD;
S. Michele Owen, PhD; Pragna Patel, MD; Adria Prosser, PhD; Richard M. Selik, MD; R. Luke Shouse, MD; Allan Taylor, MD; Suzanne Whitmore, DrPH.
New HIV Testing Algorithms Preconsultation Work Group
External Members: Rashad Arcement, MSPH, Louisiana Department of Health and Hospitals, New Orleans, Louisiana; Berry Bennett, MPH, Florida
Department of Health, Tallahassee, Florida; Barbara Bolden, PhD, New Jersey Department of Health, Trenton, New Jersey; Daniel E. Gordon, New York
State Department of Health, Albany, New York; Angelique B. Griffin, MS, District of Columbia Department of Health, Washington, DC; Charulata Jain
Sabharwal, MD, New York City Department of Health and Mental Hygiene, New York, New York; Abdel Ibrahim, PhD, New Jersey Department of Health,
Trenton, New Jersey; Norman Markowitz, MD, Henry Ford Hospital, Detroit, Michigan; Eugene G. Martin, PhD, UMDNJ-Robert Wood Johnson Medical
School, Somerset, New Jersey; Tiffany West Ojo, MSPH, District of Columbia Department of Health, Washington, DC; William R. Oleszko, PhD, New York
City Department of Health and Mental Hygiene, New York, New York; Monica M. Parker, PhD, Wadsworth Center, New York State Department of Health,
Albany, New York; Sindy Paul, MD, New Jersey Department of Health & Senior Services, Trenton, New Jersey; Christopher Pilcher, MD, UCSF School of
Medicine, San Francisco General Hospital, San Francisco, California; Lisa M. Randall, PhD, Michigan Department of Community Health, Lansing, Michigan;
Lou Smith, MD, New York State Department of Health, Albany, New York; Kenneth Soyemi, MD, Illinois Department of Public Health, Springfield, IL;
Lucia V. Torian, PhD, New York City Department of Health and Mental Hygiene, New York, New York.
CDC Staff Members: Bernard Branson, MD; Kevin P. Delaney, MPH; Timothy Granade, MS; Kristen Mahle Gray; M. Patricia Joyce, MD; Richard Kline,
MS; Laurie Linley, MPH; Robin J. MacGowan, MPH; Rebecca Morgan, MPH; S. Michele Owen, PhD; Pragna Patel, MD;
Danuta Pieniazek, PhD; Richard M. Selik, MD; R. Luke Shouse, MD; Laura Wesolowski, PhD.
Acute HIV Infection Preconsultation Work Group
External Members: Rashad Arcement, MSPH, Louisiana Department of Health and Hospitals, New Orleans, Louisiana; Berry Bennett, MPH, Florida
Department of Health, Tallahassee, Florida; Jim Kent, MS, Public Health-Seattle & King County, Seattle, Washington; Eugene G. Martin, PhD, UMDNJ -
Robert Wood Johnson Medical School, Somerset, New Jersey; William R. Oleszko, PhD, New York City Department of Health and Mental Hygiene, New
York, New York; Sindy Paul, MD, New Jersey Department of Health & Senior Services, Trenton, New Jersey; Christopher Pilcher, MD, UCSF School of
Medicine, San Francisco General Hospital, San Francisco, California; Amado Punsalang, PhD, New York City Department of Health and Mental Hygiene,
New York, New York; Lou Smith, MD, New York State Department of Health, Albany, New York; Lucia V. Torian, PhD, New York City Department of
Health and Mental Hygiene, New York, New York; Cynthia Turner, Houston Department of Health and Human Services, Houston, Texas.
CDC Staff Members: Bernard Branson, MD; Hollie Clark, MPH; Samuel W. Dooley, MD; Timothy Granade, MS; M. Patricia Joyce, MD; Richard Kline,
MS; S. Michele Owen, PhD; Pragna Patel, MD; Danuta Pieniazek, PhD; Richard M. Selik, MD; R. Luke Shouse, MD.
Page 10
Recommendations and Reports
MMWR / April 11, 2014 / Vol. 63 / No. 3 9
HIV-2 Preconsultation Work Group
External Members: Lucia V. Torian, PhD, New York City Department of Health and Mental Hygiene, New York, New York.
CDC Staff Members: Bernard Branson, MD; Timothy Granade, MS; M. Patricia Joyce, MD; Richard Kline, MS; S. Michele Owen, PhD; Danuta Pieniazek,
PhD; Richard M. Selik, MD; R. Luke Shouse, MD.
Opportunistic Illnesses Preconsultation Work Group
External Members: Dena M. Bensen, MPH, Virginia Department of Health, Richmond, Virginia; Sandra Miranda de Leon, MPH, Puerto Rico Department
of Health, Rio Piedras, Puerto Rico; Rebecca Grigg, PhD, Florida Department of Health, Tallahassee, Florida; Jerry Harms, MPH, Iowa Department of Public
Health, Des Moines, Iowa; Sean Schafer, MD, Oregon Department of Human Services, Portland, Oregon; Sandy Schwarcz, MD, University of California
at San Francisco, San Francisco, California; Thomas Shavor, MBA. Tennessee Department of Health, Nashville, Tennessee; Linda Slinkard, Indiana State
Department of Health, Indianapolis, Indiana; Steven Starr, California Department of Health, Sacramento, California; Flora Zorn, MPH, South Carolina
Department of Health and Environmental Control, Columbia, South Carolina.
CDC Staff Members: M. Patricia Joyce, MD; Laurie Kamimoto, MD; Richard M. Selik, MD.
Pediatric HIV Infection Preconsultation and Post-Consultation Work Groups
External Members: Dena M. Bensen, MPH, Virginia Department of Health, Richmond, Virginia; Kathleen A. Brady, MD, Philadelphia Department of
Public Health, Philadelphia, Pennsylvania; Michael T. Brady, MD, Nationwide Childrens Hospital, Cincinnati, Ohio; Rana Chakraborty, MD, Emory
University, Atlanta, Georgia; Patricia M. Flynn, MD, St. Jude Childrens Research Hospital, Memphis, Tennessee; Toni Frederick, PhD, MSPH, Los Angeles
County Department of Health Services, Los Angeles, California; Peter L. Havens, MD, Medical College of Wisconsin, Wauwatosa, Wisconsin; Rohan Hazra,
MD, National Institute of Child Health and Human Development, NIH, Rockville, Maryland; Gloria P. Heresi, MD, University of Texas Medical School;
Houston, Texas; Lorene Maddox, MPH, Florida Department of Health, Tallahassee, Florida; Mary Michaud, New Jersey Department of Health and Senior
Services, Trenton, New Jersey; Lynne M. Mofenson, MD, National Institute of Child Health and Human Development, NIH, Rockville, Maryland; Eve
Mokotoff, MPH, Michigan Department of Community Health, Detroit, Michigan; Azita Naghdi, MPH, Los Angeles County Department of Health Services,
Los Angeles, California; Paul E. Palumbo, MD, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; Mary E. Paul, MD, Baylor College of
Medicine, Houston, Texas; Savita Pahwa, MD, University of Miami, Miami, Florida; Vicki B. Peters, MD, New York City Department of Health and Mental
Hygiene, New York, New York; Richard M. Rutstein, MD, Childrens Hospital of Philadelphia, Philadelphia, Pennsylvania; Gwendolyn Scott, MD, University
of Miami, Miami, Florida; George K. Siberry, MD, MPH, National Institute of Child Health and Human Development, Bethesda, Maryland; Kenneth
Soyemi, MD, Illinois Department of Public Health, Springfield, IL; Russell Van Dyke, MD, Tulane University School of Medicine, New Orleans, Louisiana.
CDC Staff Members: Kenneth Dominguez, MD; Steve Nesheim, MD; Richard M. Selik, MD, Allan W. Taylor, MD; Suzanne Whitmore, DrPH.
Physician-Documented Diagnosis Preconsultation Work Group
External Members: Bridget Anderson, PhD, New York State Department of Health, Albany, New York; Colin Flynn, ScM, Maryland Department of Health
and Mental Hygiene, Baltimore, Maryland; Betsey John, MPH, Massachusetts Department of Public Health, Boston, Massachusetts; Steven Starr, California
Department of Health, Sacramento, California; Lucia V. Torian, PhD, New York City Department of Health and Mental Hygiene, New York, New York;
Attillio Zarrella, ThD, Maryland Department of Health and Mental Hygiene, Baltimore, Maryland.
CDC Staff Members: Richard M. Selik, MD; R. Luke Shouse, MD.
Disclosure of Competing Interests
The federal government employees who prepared this report have no conflict of interest with the manufacturers of the products discussed herein. Competing
interests for non-CDC contributors were not assessed except for the five experts who reviewed a draft of this manuscript (external peer review described at
http://www.cdc.gov/hiv/pdf/policies_PRP_Revised_HIV_Case_Def.pdf ); they had no competing interests.
Page 11
Recommendations and Reports
10 MMWR / April 11, 2014 / Vol. 63 / No. 3
Bacterial infections, multiple or recurrent*
Candidiasis of bronchi, trachea, or lungs
Candidiasis of esophagus
Cervical cancer, invasive
Coccidioidomycosis, disseminated or extrapulmonary
Cryptococcosis, extrapulmonary
Cryptosporidiosis, chronic intestinal (>1 months duration)
Cytomegalovirus disease (other than liver, spleen, or nodes), onset at age >1 month
Cytomegalovirus retinitis (with loss of vision)
Encephalopathy attributed to HIV
§
Herpes simplex: chronic ulcers (>1 months duration) or bronchitis, pneumonitis, or esophagitis (onset at age >1 month)
Histoplasmosis, disseminated or extrapulmonary
Isosporiasis, chronic intestinal (>1 months duration)
Kaposi sarcoma
Lymphoma, Burkitt (or equivalent term)
Lymphoma, immunoblastic (or equivalent term)
Lymphoma, primary, of brain
Mycobacterium avium complex or Mycobacterium kansasii, disseminated or extrapulmonary
Mycobacterium tuberculosis of any site, pulmonary
, disseminated, or extrapulmonary
Mycobacterium, other species or unidentified species, disseminated or extrapulmonary
Pneumocystis jirovecii (previously known as “Pneumocystis carinii”) pneumonia
Pneumonia, recurrent
Progressive multifocal leukoencephalopathy
Salmonella septicemia, recurrent
Toxoplasmosis of brain, onset at age >1 month
Wasting syndrome attributed to HIV
§
Appendix: Stage-3-Defining Opportunistic Illnesses in HIV Infection
* Only among children aged <6 years.
Only among adults, adolescents, and children aged ≥6 years.
§
Suggested diagnostic criteria for these illnesses, which might be particularly important for HIV encephalopathy and HIV wasting syndrome, are described in the
following references:
CDC. 1994 Revised classification system for human immunodeficiency virus infection in children less than 13 years of age. MMWR 1994;43(No. RR-12).
CDC. 1993 Revised classification system for HIV infection and expanded surveillance case definition for AIDS among adolescents and adults. MMWR 1992;41(No. RR-17).
Page 12
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Page 13
  • Source
    • "According to Center Disease Control (CDC) [1], the revised definition of AIDS criteria includes the biological criteria (CD4 below 200) and/or clinical criteria (opportunistic infections, cancers of the cervix, Kaposi sarcoma, and non- Hodgkin lymphoma) associated with infection by human immunodeficiency virus (HIV). "
    [Show abstract] [Hide abstract] ABSTRACT: Aim . To determine the prevalence of HIV infection among patients seen at the surgical oncology unit of Donka (Conakry, Guinea). Method . We conducted a retrospective and descriptive study of HIV infection in cancer patients from May 2007 to December 2012. Social characteristics (age, gender, marital status, and education) and immune status (HIV type, CD4 count) were reviewed. Results . Out of 2598 cancer patients, 54 (2.1%) tested positive for HIV. There were 11 (20.4%) defining AIDS and 43 (79.6%) nondefining AIDS cancers. The most frequent cancers were breast (14) (26.0%), non-Hodgkin lymphoma (6) (11.1%), liver (6) (11.1%), eye and annexes (6) (11.1%), and cervical cancer (5) (9.3%). These patients were female in 34 (63.0%) and had a median age of 39 years and body mass index was 20,3 Kg/m 2 . They were unschooled in 40 (74.1%) and married in 35 (64.8%). CD4 count showed a median of 317 cells/mL. Antiretroviral treatment was performed in 40 (74.1%). Conclusion . HIV prevalence is higher in patients in our unit of surgical oncology. Breast cancer was the most common in this association. A national survey of a large sample is needed to determine the true prevalence and impact of HIV on cancer prognosis.
    Full-text · Article · Jan 2015 · Journal of Cancer Epidemiology
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    [Show abstract] [Hide abstract] ABSTRACT: In the United States, of the 1.1 million persons infected with human immunodeficiency virus (HIV) and the 2.7 million infected with hepatitis C virus (HCV), approximately 16% and 50%, respectively, are unaware of their infection. Highly effective treatments have turned both diseases into manageable conditions, and in the case of hepatitis C, a disease that can be cured. Early diagnosis is imperative so that infected persons can take measures to stay healthy, get into care, benefit from therapy, and reduce the risk of transmission. In this report, we review current recommendations provided by the Centers for Disease Control and Prevention (CDC) and the United States Preventive Services Task Force on whom to screen for HIV and HCV infections, and recommendations from the CDC, the Association of Public Health Laboratories, and the Clinical and Laboratory Standards Institute on how to test for these infections.
    Full-text · Article · May 2014 · Clinical Infectious Diseases
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    [Show abstract] [Hide abstract] ABSTRACT: This document updates recommendations for HIV testing by laboratories in the United States and offers approaches for reporting test results to persons ordering HIV tests and to public health authorities. The recommended algorithm is a sequence of tests used in combination to improve the accuracy of the laboratory diagnosis of HIV based on testing of serum or plasma specimens. In brief, testing begins with a combination immunoassay that detects HIV-1 and HIV-2 antibodies and HIV-1 p24 antigen. All specimens reactive on this initial assay undergo supplemental testing with an immunoassay that differentiates HIV-1 from HIV-2 antibodies. Specimens that are reactive on the initial immunoassay and nonreactive or indeterminate on the antibody differentiation assay proceed to HIV-1 nucleic acid testing for resolution.
    Full-text · Technical Report · Jun 2014
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