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Clinical Categories for Children Aged < 13 Years With HIV Infection

Clinical Categories for Children Aged < 13 Years With HIV Infection

Category N: Not symptomatic

Children who have no symptoms or signs considered to result from HIV infection or who have only 1 of the conditions listed in category A

Category A: Mildly symptomatic

Children with ≥ 2 of the conditions listed below but none of the conditions listed in category B or C:

Dermatitis

Hepatomegaly

Lymphadenopathy ( 0.5 cm at > 2 sites; bilateral = 1 site)

Parotitis

Recurrent or persistent upper respiratory tract infection, sinusitis, or otitis media

Splenomegaly

Category B: Moderately symptomatic

Children with symptomatic conditions attributed to HIV infection beyond those listed in category A but not among those listed in category C; conditions in category B include but are not limited to the following:

Anemia (hemoglobin < 8 g/dL [< 80 g/L]), neutropenia (< 1,000/mcL [< 1 × 109/L]), or thrombocytopenia (< 100,000/mcL [< 100 × 109/L]) persisting 30 days

Bacterial meningitis, pneumonia, or sepsis (single episode)

Candidiasis, oropharyngeal (thrush), persisting (> 2 months) in children > 6 months of age

Cardiomyopathy

Cytomegalovirus infection with onset before 1 month of age

Diarrhea, recurrent or chronic

Hepatitis

Herpes zoster (shingles) involving 2 distinct episodes or > 1 dermatome

HSV stomatitis, recurrent (> 2 episodes within 1 year)

HSV bronchitis, pneumonitis, or esophagitis with onset before 1 month of age

Leiomyosarcoma

Lymphoid interstitial pneumonitis or pulmonary lymphoid hyperplasia complex

Nephropathy

Nocardiosis

Persistent fever (lasting > 1 month)

Toxoplasmosis with onset before 1 month of age

Varicella, disseminated (complicated chickenpox)

Category C: Severely symptomatic (stage 3–defining opportunistic infections)

Children with ≥ 1 of the following conditions:

Serious bacterial infections, multiple or recurrent (ie, any combination of 2 culture-confirmed infections within a 2-year period), of the following types: septicemia, pneumonia, meningitis, bone or joint infection, or abscess of an internal organ or body cavity (excluding otitis media, superficial skin or mucosal abscesses, and indwelling catheter-related infections) in a child < 6 years of age

Candidiasis, esophageal or pulmonary (bronchi, trachea, lungs)

Cervical cancer, invasive, in a child or adolescent ≥ 6 years of age

Coccidioidomycosis, disseminated (at a site other than or in addition to the lungs or cervical or hilar lymph nodes)

Cryptococcosis, extrapulmonary

Cryptosporidiosis (chronic intestinal) or isosporiasis (chronic intestinal) with diarrhea persisting > 1 month

Cytomegalovirus disease with onset of symptoms at age > 1 month (at a site other than the liver, spleen, or lymph nodes)

Cytomegalovirus retinitis (with loss of vision)

Encephalopathy ( 1 of the following progressive findings present for 2 months in the absence of a concurrent illness other than HIV infection that could explain the findings):

  • Failure to attain or loss of developmental milestones or loss of intellectual ability, verified by standard developmental scale or neuropsychologic tests

  • Impaired brain growth or acquired microcephaly shown by head circumference measurements or presence of brain atrophy on CT or MRI (serial imaging is required for children < 2 years)

  • Acquired symmetric motor deficit manifested by 2 of the following: paresis, pathologic reflexes, ataxia, or gait disturbance

Histoplasmosis, disseminated (at a site other than or in addition to the lungs or cervical or hilar lymph nodes)

HSV infection causing a mucocutaneous ulcer persisting for > 1 month or HSV bronchitis, pneumonitis, or esophagitis for any duration affecting a child > 1 month of age

Kaposi sarcoma

Lymphoma, primary, in the brain

Lymphoma: Small, noncleaved cell lymphoma (Burkitt), or immunoblastic or large-cell lymphoma of B-cell or unknown immunologic phenotype

Mycobacterium tuberculosis, pulmonary, disseminated, or extrapulmonary (at any site)

Mycobacterium avium complex, Mycobacterium kansasii, or other species or unidentified species, disseminated or extrapulmonary

Pneumocystis jirovecii pneumonia

Pneumonia, recurrent, in children or adolescents ≥ 6 years of age

Progressive multifocal leukoencephalopathy

Salmonella (nontyphoid) septicemia, recurrent

Toxoplasmosis of the brain with onset at > 1 month of age

Wasting syndrome in the absence of a concurrent illness (other than HIV infection) that could explain any one of the following 3 findings:

  • Persistent weight loss > 10% of baseline

  • Downward crossing of 2 of the following percentile lines on the weight-for-age chart (eg, 95th, 75th, 50th, 25th, 5th) in a child 1 year

  • < 5th percentile on weight-for-height chart on 2 consecutive measurements 30 days apart

plus 1 of the following:

  • Chronic diarrhea (ie, 2 loose stools/day for 30 days)

  • Documented fever (for 30 days, intermittent or constant)

HSV = herpes simplex virus.

Adapted from Centers for Disease Control and Prevention: 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 of age—United States, 2008. Morbidity and Mortality Weekly Report 57(RR-10):1–13, 2008; and Centers for Disease Control and Prevention: Revised surveillance case definition for HIV infection–United States, 2014. Morbidity and Mortality Weekly Report 63(RR-3):1–10, 2014.