WHO CLINICAL STAGING

OF HIV/AIDS
•STAGE –1
•STAGE – 2
•STAGE – 3
•STAGE – 4
Clinical Stage 1
Asymptomatic
Persistent generalized lymphadenopathy

Clinical Stage 2
Moderate unexplained weight loss
(<10% of presumed or measured body weight)
Recurrent respiratory tract infections
Herpes zoster
Angular cheilitis
Recurrent oral ulcerations
Papular pruritic eruptions
Fungal nail infections of fingers
Clinical Stage 3
 Severe weight loss (>10% of presumed or measured body
weight)
 Unexplained chronic diarrhoea for longer than one month
 Unexplained persistent fever (intermittent or constant for
longer than one month)
 Oral candidiasis
 Oral hairy leukoplakia
 Pulmonary tuberculosis (TB) diagnosed in last two years
 Severe presumed bacterial infections (e.g. pneumonia,
empyema, pyomyositis, bone or joint infection, meningitis,
bacteraemia)
 Acute necrotizing ulcerative stomatitis, gingivitis or
periodontitis
Clinical Stage 4
 HIV wasting syndrome
 Pneumocystis pneumonia
 Recurrent severe or radiological bacterial pneumonia
 Chronic herpes simplex infection (more than one month’s
duration)
 Oesophageal candidiasis
 Extrapulmonary TB
 Kaposi’s sarcoma
 Central nervous system (CNS) toxoplasmosis
 HIV encephalopathy
 CD4 LEVELS IN RELATION TO THE
SEVERITY OF IMMUNOSUPPRESSION

SEVERITY CD 4 LEVELS

Not significant immunosuppression >500/cu mm

Mild immunosuppression 350 − 499/cu mm

Advanced immunosuppression 200 −349/cu mm

Severe immunosuppression <200/cu mm

WHEN TO START ART
 Clinical condition Recommendation
WHO Clinical Stage 1 Start ART if CD4 ≤350

WHO Clinical Stage 2 Start ART if CD4 ≤350

WHO Clinical Stage 3 or 4 Start ART irrespective of CD4 cell

count

Active TB disease Start ART irrespective of CD4 cell

count

HBV co-infection requiring therapy Start ART irrespective of CD4 cell

count
 MONITORING OF PATIENT ON
ART
 CLINICAL MONITORING
Monitoring of adherence
Monitoring of tolerance
Monitoring of Efficacy

 LABORATORY MONITORING
 Monitoring of Adherence
Adherence to ART is essential and more than 95%
adherence is required for effectiveness of therapy

Monitoring of Tolerance
Causes of any new symptoms and signs
should be identified after initiation of ART
 Monitoring of Efficacy
Indicators for improvement in the patient’s condition
would be
 Gain in body weight
 Decrease in frequency or severity of opportunistic
infections
 Increase in CD4 count of 100-200 cells per year (this
may be less if initial CD4 <50)
 Increase in total lymphocyte count
 Increase in platelets if low at the start
 Sustained suppression of viral load
 LABORATORY MONITORING
 Full blood count including platelet count
(patients on Zidovudine may require frequent
Hb monitoring )
 Fasting Blood Sugar (if the patient is on PIs)
 Liver function tests (ALT, AST)
 Renal function tests (Tenofovir)
 ART REGIMEN
 The following triple therapy regimens are
recommended:
 2 Nucleoside Reverse Transcriptase Inhibitors (NRTIs) and
1 Non-Nucleoside Reverse Transcriptase Inhibitor (NNRTI)

 2 NRTIs and 1 Protease Inhibitor (PI)

 FIRST LINE DRUGS
Zidovudine+Lamivudine+Nevirapine
(Stavudine +Lamivudine+Nevirapine)
(Zidovudine+Lamivudine+Efavirenz )

SECOND LINE DRUGS

Abacavir + Tenofovir + Lopinavir
Didanosine + Abacavir + Nelfinavir
THANK
YOU