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HIV
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Case Definition of AIDS-defining Illnesses
in Australia
Centers for Disease Control
classification of HIV infection
The AIDS case definition in Australia includes a
confirmed diagnosis of HIV-1 infection and one or more of the following
AIDS-defining illnesses, diagnosed presumptively or definitively according
to the criteria listed below.
Candidiasis of the bronchi, trachea or lungs
Gross inspection by endoscopy or at autopsy or by
microscopy (histology or cytology) on a specimen obtained directly from
the tissues affected (including scrapings from the mucosal surface) not
from a culture.
Candidiasis, oesophageal
Definitive diagnosis
As for candidiasis of the bronchi, trachea or lungs.
Presumptive diagnosis:
recent onset of retrosternal pain on swallowing;
and
oral candidiasis diagnosed by the gross appearance of white
patches or plaques on an erythematous base or by the microscopic
appearance of fungal mycelial filaments in an uncultured specimen scraped
from the oral mucosa.
Cervical cancer, invasive
Histological evidence of cancer.
Coccidiomycosis, disseminated or extrapulmonary
Microscopy (histology or cytology), culture or detection
of antigen in a specimen obtained directly from the affected tissues or a
fluid from those tissues.
Cryptococcosis, extrapulmonary
Microscopy (histology or cytology), culture or detection
of antigen in a specimen obtained directly from the affected tissues or a
fluid from those tissues.
Cryptosporidiosis, of more than one month’s duration
Microscopy (histology or cytology), culture or detection
of antigen in a specimen obtained directly from the affected tissues or a
fluid from those tissues.
Cytomegalovirus disease, other than liver, spleen or nodes
Microscopy (histology or cytology), culture or detection
of antigen in a specimen obtained directly from the affected tissues or a
fluid from those tissues.
Cytomegalovirus retinitis, with loss of vision
Definitive diagnosis
As for cytomegalovirus disease, other than liver, spleen
or lymph nodes.
Presumptive diagnosis
A characteristic appearance on serial ophthalmoscopic
examinations, for example discrete patches of retinal whitening with
distinct borders, spreading in a centrifugal manner along the paths of
blood vessels, progressing over several months, and frequently associated
with retinal vasculitis, haemorrhage, and necrosis. Resolution of active
disease leaves retinal scarring and atrophy with retinal pigment
epithelial mottling.
Encephalopathy, HIV related
Clinical findings of disabling cognitive or motor
dysfunction interfering with occupation or activities of daily living,
progressing over weeks to months, in the absence of a concurrent illness
or condition other than HIV infection that could explain the findings.
Methods to rule out such concurrent illness and conditions must include
cerebrospinal fluid examination and either brain imaging (computed
tomography or magnetic resonance) or autopsy.
Herpes simplex: chronic ulcer(s) of more than one month’s duration,
bronchitis, pneumonitis or oesophagitis
Microscopy (histology or cytology), culture or detection
of antigen in a specimen obtained directly from the affected tissues or a
fluid from those tissues.
Histoplasmosis, disseminated or extrapulmonary
Microscopy (histology or cytology), culture or detection
of antigen in a specimen obtained directly from the affected tissues or a
fluid from those tissues.
Isosporiasis, chronic intestinal, of more than one month’s duration
Microscopy (histology or cytology), culture or detection
of antigen in a specimen obtained directly from the affected tissues or a
fluid from those tissues.
Kaposi’s sarcoma
Definitive diagnosis
Microscopy (histology or cytology).
Presumptive diagnosis
A characteristic gross appearance of an erythematous or
violaceous plaque-like lesion on skin or mucous membrane. (Note: A
presumptive diagnosis of Kaposi’s sarcoma should not be made by
clinicians who have only seen few cases).
Lymphoma, Burkitt’s
Microscopy (histology or cytology).
Lymphoma, immunoblastic
Microscopy (histology or cytology).
Lymphoma, primary, of brain
Microscopy (histology or cytology).
Mycobacterium tuberculosis, any site, pulmonary or extrapulmonary
Definitive diagnosis
Isolation of Mycobacterium tuberculosis, M.
bovis or M. africanum from a clinical specimen
Presumptive diagnosis
Demonstration of acid-fast bacilli in a clinical
specimen or, when a culture is not available, in a histopathological
lesion in a person with signs or symptoms compatible with tuberculosis; or
evidence of resolution of disease where treatment with two or more
antituberculosis medications have been prescribed and follow-up has been
instigated.
Mycobacterial disease (other or unidentified species), disseminated or
extrapulmonary
Definitive diagnosis
Culture.
Presumptive diagnosis
Microscopy of a specimen from stool or normally sterile
body fluids, or tissue from a site other than lungs, skin or cervical or
hilar lymph nodes that shows acid-fast bacilli of a species not identified
by culture.
Pneumocystis carinii pneumonia
Definitive diagnosis
Microscopy (histology or culture).
Presumptive diagnosis
- a history of dyspnoea on exertion or non-productive
cough of recent onset (within the past three months); and
- chest X-ray evidence of diffuse bilateral
interstitial infiltrates or evidence by gallium scan of diffuse
bilateral pulmonary disease; and
- arterial blood gas analysis showing arterial pO2 less
than 70 mm Hg, or low respiratory diffusing capacity (less than 80 per
cent of predicted values), or an increase in the alveolar-arterial
oxygen tension gradient; and
- no evidence of bacterial pneumonia.
Pneumonia, recurrent bacterial
Definitive diagnosis
Two or more episodes of acute pneumonia occurring within
twelve months. Both episodes must have infection with a pathogen that
typically causes pneumonia (other than P. carinii or M. tuberculosis)
proven by culture or some other organism-specific diagnostic method and
new (not present earlier) radiological evidence of pneumonia.
Presumptive diagnosis
Two or more episodes occurring within twelve months of
acute pneumonia (new symptoms, signs or X-ray evidence not present
earlier), based on clinical or radiological evidence.
Progressive multifocal leukoencephalopathy
Microscopy (histology or cytology).
Salmonella septicaemia, recurrent
Culture-proven infection with Salmonella species.
Toxoplasmosis
Definitive diagnosis
Microscopy (histology or cytology).
Presumptive diagnosis
Toxoplasmosis of the brain, based on observation of:
- recent onset of a focal neurological abnormality
consistent with intracranial disease or a reduced level of
consciousness; and
- evidence by brain imaging (computed tomography or
magnetic resonance imaging) of a lesion having a mass effect or the
radiographical appearance of which is enhanced by injection of
contrast medium;
and
- serum antibody to Toxoplasma or successful response
to therapy for toxoplasmosis.
Wasting syndrome due to HIV infection
- profound involuntary weight loss of more than 10 per
cent of baseline body weight and
- chronic diarrhoea (at least two loose stools per day
for thirty days) or
chronic weakness and documented fever (for at least thirty days,
intermittent or constant) in the absence of a concurrent illness or
condition other than HIV infection, such as tuberculosis, cancer,
cryptosporidiosis, or other specific enteritis, that could explain the
findings.
Bacterial infection affecting a child less than 13 years of age
Laboratory diagnosis of multiple or recurrent bacterial
infections (any combination of at least two within two years) of the
following types:
septicaemia, pneumonia, meningitis, bone or joint
infection, abscess of an internal organ or body cavity (excluding otitis
media or superficial skin or mucosal abscesses) caused by Haemophilus
spp., Streptococcus pneumoniae or other pyogenic bacteria.
Lymphoid interstitial pneumonia and/or pulmonary lymphoid hyperplasia
affecting a child less than 13 years of age
Definitive diagnosis
Microscopy (histology or cytology).
Presumptive diagnosis
Lymphoid interstitial pneumonia - bilateral,
reticulonodular, interstitial pulmonary infiltrates present on chest X-ray
for two months or more, with no pathogen identified and no response to
antibiotic treatment. Other causes of interstitial infiltrates should be
excluded, such as tuberculosis, Pneumocystis carinii pneumonia,
cytomegalovirus infection and other viral or parasitic infections.
US Centers for Disease Control (CDC) 1993
classification
|
Category |
CD4 Count |
|
>500 |
200 -500 |
<200 |
| (A) Asymptomatic, primary HIV, PGL |
A1 |
A2 |
A3 |
|
(B) Symptomatic, not (A) or (C) |
B1 |
B2 |
B3 |
|
(C) AIDS-defining conditions |
C1 |
C2 |
C3 |
|
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