Definition and diagnosis Stipulations of WHO and CDC about the diagnosis standard and case definition of AIDS
1.Diagnosis standard of AIDS
In March 1986, WHO, with American CDC standard as chief source, published ¡°The diagnosis standard of AIDS¡±, of which the diagnosis standard of adults with AIDS is as follows:
Except positive results in serology and virology, an adult can be diagnosed as AIDS at least with two items of the major physical signs and one item of the secondary physical sign.
Major physical sings: ¢Ù? Body weight reduced over 10%, ¢Ú Chronic diarrhea sustained over 1 month, ¢Û fever sustained over 1 month.
Secondary physical signs: ¢Ù Stubborn cough sustained over 1 month, ¢Ú Systemic itching dermatitis, ¢Û Recurrent band shaped skin rash, ¢Ü Moniliasis in the mouth and throat, ¢Ý Simple bleb infection (chronic progressive or disseminated), ¢Þ Systemic enlargement of lymph nodes.
2. Classification of clinical manifestation proposed by American Center of Disease Control (CDC)
Group I: Acute HIV infection clinically manifested as transient infected mononucleosis, serum HIV antibody positive.
Group II: HIV infection without clinical symptom, serum HIV antibody positive.
Group III: Persistent systemic enlargement of lymph nodes, not at groin, numbering over 3, diameter over 1cm and sustained 3 months with cause not known.
Group IV: with other clinical symptoms, further divided into 5 subgroups:
Subgroup A: With non specific systemic symptom, such as fever, diarrhea and reduction of body weight over 10%, persistent for more than 1 month and non other cause having been found out.
Subgroup B: Manifested as nervous system symptoms, such as dementia, myelopathy and peripheral nerve disease with cause not known.
Subgroup C: Double infection induced cell immunodeficiency after HIV infection, and further divided into two types:
C1: Frequently encountered AIDS infection recorded by CDC from 1982 to 1985: Pneumocystitis Carinii pneumonia, chronic cryptosporidiosis, toxoplasmosis, strongyloidosis, candidiasiss (esophagus, bronchus and lung), crytococcosis, histoplasmosis, mycbacterium tuberculosis avium infection, cytomegalovirds infection, chronic disseminated herpes viral infection and progressive multifocal white substance cephalitis.
C2: Other frequently seen infection: hairy mouth membrane leukoderma, herpes zoster, recurrent salmonella blood disease, nocardiosis, tuberculosis and mouth moniliasis.
Subgroup D: Secondary tumor, mainly Kaposi¡¯s sarcoma, non-Hodgkin¡¯s lymphoma, primary brain lymphoma.
Subgroup E: Other subgroup complications induced by cell immune function incompleteness and not belonging to other subgroups, such as chronic interstitial pneumonia.
3.AIDS diagnosis standard established by WHO and American CDC
The AIDS case definitions revised by WHO and American CDC in 1987 for the purpose of AIDS monitoring stipulated that the report on each AIDS case to the state should be determined on whether there is one or two characteristics of the following indicative diseases (opportunistic infection and malignancy) and laboratory evidence of HIV infection.
3.1Diagnosis of AIDS infection without laboratory evidence
If laboratory HIV examination has not been conducted and there isn¡¯t confirmative experimental result, and the immunodeficiency pathogeny listed in clause 3.1.1, the patient can be diagnosed as AIDS in case the patient is suffering from any one disease described in clause 3.1.2.
3.1.1 Lacking experimental evidence and any one item of the following immunodeficiency pathogeny has been confirmed, the patient should not be diagnosed as AIDS.
Within ¡Ü3 months before an indicative disease happens, the disease has been treated with ???large dosage or long-term systemic corticosteroid drug or other immunosuppressant.
Within ¡Ü3 months after the indicative disease has been diagnosed, any one of the following ??diseases has occurred: hodgkin¡¯s disease, non-Hodgkin¡¯s lymphoma£¨excluding primary brain lymphoma£©, lymphocytic leukaemia, multiple myeloma, any kind of lymph net shaped endothelial cell or histiocyte tumor and blood vessel immune matricyte lymphadenopathy.
Genetic (congenital) immunodeficiency syndrome or immunodeficiency syndrome acquired ???due to atypism HIV infection, such as hypogammaglobulinemia.
3.1.2 The following confirmed indicative diseases can be diagnosed as AIDS:
Esophagus, trachea, bronchus, and lung moniliasis.
Crytococcosis out of lung.
Cryptosploridiosis with diarrhea sustained over a month.
Patient over a month with his organs being infected by cytomegalo virus except liver, spleen and lymph gland.
Mucous membrane ulceration incurred by simple herpesvirus infection and sustained for over 3.1.2 month or bronchitis, pneumonia, and esophagitis suffered over 1 month.
Kaposi¡¯s sarcoma suffered by patient over 60 years old.
Primary brain lymphoma suffered by patient under 60 years old.
lymphatic interstitial pneumonia and/or lung lymphatic hyperplasia (LOP/PLH) complex suffered by children under 13 years old.
Diffused mycobacterium avium complex or Kansas mycobactericsis (at a location except lung, skin, cervix or anus lymph gland or simultaneously at all the locations)
Pneumocystitis Carinii pneumonia.
Progressive and multifocal leukoencephalopathy.
Brain toxoplasmosis suffered for over 1 month.
With laboratory evidence of HIV infection
No matter whether the pathogeny of other immunodeficiency listed in 3.1.1 exists, only there are evidence of HIV infection and any one kind of disease listed in 3.1.2 or 3.2.1or 3.2.2, it can be diagnosed as AIDS.
3.2.1 The following confirmed and indicative diseases can be diagnosed as AIDS.
Children under 13 years old and suffered within 2 years 2 or over 2 kinds of the following bacterial infection (several times or repeatedly attack): blood poisoning, pneumonia, meningitis, bone or joint infection, or viscera and body cavity abscess (excluding tympanitis, scarfskin or mucous membrane abscess) incurred by hemophilus, streptococcus (including pneumococcus) and purulent bacteria.
Disseminated coccidioidomycosis (at a location except lung, skin, cervix or anus lymph gland or simultaneously at all the locations).
HIV encephalopathy (also called ¡°HIV dementia¡± and ¡°AIDS dementia¡± or sub acute cephalitis caused by HIV).
Disseminated asmosis (at a location except lung, skin, cervix or anus lymph gland or simultaneously at all the locations).
Isosporiasis with sustained diarrhea over 1 month.
Kaposi¡¯s sarcoma suffered by patient at any age.
Primary cerebral lymphoma at any age.
Other cell B or unknown immunological phaenotype non-Hodgkin¡¯s lymphoma and the following histological somatotypes
Small non-differentiated type lymphoma (Burkitt or non Burkitt)
Immune matricyte sarcoma (any one of the following types, needing no combination: Immune matricyte erythema, large cell lymphoma, disseminated histiocyte lymphoma, disseminated small un-differentiated lymphoma or macromolecule lymphoma)
Note: The lymphomas of ¡°lymphocytic type¡±, ¡°lymphoblast type¡±, ¡°small differentiated type¡± and ¡°cytoplasmic lymphoblast type¡± described or not described in T cell immunological phaenotype or histological type are not included.
Any disseminated mycobactericsis (at a location except lung, skin, cervix or anus lymph gland or simultaneously at all the locations) caused by mycobacteris except tubercle bacillus.
Diseases outside of the lung caused by tubercle bacillus (endangering a location outside of the lung no matter whether there is any disease in it).
Recurrent non typhoid salmonella blood poisoning.
HIV exhaustive syndrome. (Also called marasmus).
3.2.2 Quasi-diagnosed indicative diseases Note: For the patient with serious indicative diseases, especially with serious side effects during treatment or it is confirmed to treat with antiretroviral drug, it generally needs an accurate diagnosis. However, under some conditions, it is impossible for the patient to conduct further examination, and therefore, a quasi-diagnosis is made on the basis of the patient¡¯s clinical features and abnormal laboratory results.
Cytomegalo viral retinitis accompanied by impaired vision.
Lymphatic interstitial pneumonia and/or lung lymphatic hyperplasia (LOP/PLH) complex suffered by children under 13 years old.
Disseminated mycobacterium infection (not the acid-fast bacillus evidenced by culture method, endangering at least a location except lung, skin, cervix or anus lymph gland or all the locations have been simultaneously infected).
Pneumocysitis Carinii pneumonia.
Patient with brain toxoplasmosis over 1 month.
3.3Laboratory test negative of HIV infection
If the laboratory test result is negative, the diagnosis of AIDS can be denied in terms of monitoring, except:
All the causes that may cause immunodeficiency described in above-mentioned 3.1.1, and,
The patient has taken any one of the following diseases:A? Confirmed pneumocystitis Carinii pneumonia, or B? ¢Ù Any one indicative disease described in above 3.1.2 has been confirmed, and¢Ú T accessory cells (CD4) count <400/mm3.