Appendix C: CDC Pediatric HIV CD4 Cell Count/Percentage and HIV-Related Diseases Categorization

Table A. HIV Infection Stage Based on Age-Specific CD4 Count or Percentage
Stagea Aged <1 Year Aged 1 Year to <6 Years Aged ≥6 Years
Cells/mm3 % Cells/mm3 % Cells/mm3

%

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
a The stage is based primarily on the CD4 count; the CD4 count takes precedence over the CD4 percentage, and the percentage is considered only when the count is missing. If a Stage 3–defining condition has been diagnosed (see Table 6), then the stage is 3, regardless of CD4 test results.
Key: CD4 = CD4 T lymphocyte
Source: Centers for Disease Control and Prevention. Revised surveillance case definition for HIV infection—United States, 2014. MMWR 2014;63 (No. RR-3):1-10.

 

Table B. HIV Infection Stage Based on Age-Specific CD4 Count or Percentage
Mildly Symptomatic

Children with two or more of the following conditions, but none of the conditions listed in the Moderately Symptomatic category, are considered mildly symptomatic:

  • Lymphadenopathy (lymph nodes are ≥0.5 cm at more than two sites and/or bilateral at one site)
  • Hepatomegaly
  • Splenomegaly
  • Dermatitis
  • Parotitis
  • Recurrent or persistent upper respiratory tract infection, sinusitis, or otitis media
Moderately Symptomatic
  • Anemia (hemoglobin <8 g/dL [<80 g/L]), neutropenia (white blood cell count <1,000 per µL [<1.0 × 109 per L]), and/or thrombocytopenia (platelet count <100 × 103 per µL [<100 × 109 per L]) persisting for ≥30 days
  • Bacterial meningitis, pneumonia, or sepsis (single episode)
  • Candidiasis, oropharyngeal (thrush), persisting for >2 months in children aged >6 months
  • Cardiomyopathy
  • CMV infection, with onset before age 1 month
  • Diarrhea, recurrent or chronic
  • Hepatitis
  • HSV stomatitis, recurrent (more than two episodes within 1 year)
  • HSV bronchitis, pneumonitis, or esophagitis with onset before age 1 onth
  • Herpes zoster (shingles) involving at least two distinct episodes or more than one dermatome
  • Leiomyosarcoma
  • Lymphoid interstitial pneumonia or pulmonary lymphoid hyperplasia complex
  • Nephropathy
  • Nocardiosis
  • Persistent fever (lasting >1 month)
  • Toxoplasmosis, onset before age 1 month
  • Varicella, disseminated (complicated chickenpox)
AIDS-Defining Conditions
  • Bacterial infections, multiple or recurrenta
  • Candidiasis of bronchi, trachea, or lungs
  • Candidiasis of esophagus
  • Cervical cancer, invasive
  • Coccidioidomycosis, disseminated or extrapulmonary
  • Cryptococcosis, extrapulmonary
  • Cryptosporidiosis, chronic intestinal (>1-month duration)
  • CMV disease (other than liver, spleen, or lymph nodes), onset at age >1 month
  • CMV retinitis (with loss of vision)
  • Encephalopathy attributed to HIVb
  • HSV: chronic ulcers (>1-month duration) or bronchitis, pneumonitis, or esophagitis (onset at age >1 month)
  • Histoplasmosis, disseminated or extrapulmonary
  • Isosporiasis, chronic intestinal (>1-month 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, recurrentc
  • Progressive multifocal leukoencephalopathy
  • Salmonella septicemia, recurrent
  • Toxoplasmosis of brain, onset at age >1 month
  • Wasting syndrome attributed to HIVb

a Only among children aged <6 years.

b Suggested diagnostic criteria for these illnesses, which might be particularly important for HIV encephalopathy and HIV wasting syndrome, are described in the following references:

Centers for Disease Control and Prevention. 1994 Revised classification system for human immunodeficiency virus infection in children less than 13 years of age. MMWR. 1994;43(No. RR-12).

Centers for Disease Control and Prevention. 1993 Revised classification system for HIV infection and expanded surveillance case definition for AIDS among adolescents and adults. MMWR. 1992;41(No. RR-17).

c Only among adults, adolescents, and children aged ≥6 years.

Key: CMV = cytomegalovirus; HSV = herpes simplex virus

Modified from:

Centers for Disease Control and Prevention. 1994 revised classification system for human immunodeficiency virus infection in children less than 13 years of age. MMWR. 1994;43(No. RR-12).

Centers for Disease Control and Prevention: Revised Surveillance Case Definition for HIV Infection—United States, 2014. MMWR. 2014;63(No. RR-3):1-10.

Table A. HIV Infection Stage Based on Age-Specific CD4 Count or Percentage
Stagea Aged <1 Year Aged 1 Year to <6 Years Aged ≥6 Years
Cells/mm3 % Cells/mm3 % Cells/mm3

%

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
a The stage is based primarily on the CD4 count; the CD4 count takes precedence over the CD4 percentage, and the percentage is considered only when the count is missing. If a Stage 3–defining condition has been diagnosed (see Table 6), then the stage is 3, regardless of CD4 test results.
Key: CD4 = CD4 T lymphocyte
Source: Centers for Disease Control and Prevention. Revised surveillance case definition for HIV infection—United States, 2014. MMWR 2014;63 (No. RR-3):1-10.

 

Table B. HIV Infection Stage Based on Age-Specific CD4 Count or Percentage
Mildly Symptomatic

Children with two or more of the following conditions, but none of the conditions listed in the Moderately Symptomatic category, are considered mildly symptomatic:

  • Lymphadenopathy (lymph nodes are ≥0.5 cm at more than two sites and/or bilateral at one site)
  • Hepatomegaly
  • Splenomegaly
  • Dermatitis
  • Parotitis
  • Recurrent or persistent upper respiratory tract infection, sinusitis, or otitis media
Moderately Symptomatic
  • Anemia (hemoglobin <8 g/dL [<80 g/L]), neutropenia (white blood cell count <1,000 per µL [<1.0 × 109 per L]), and/or thrombocytopenia (platelet count <100 × 103 per µL [<100 × 109 per L]) persisting for ≥30 days
  • Bacterial meningitis, pneumonia, or sepsis (single episode)
  • Candidiasis, oropharyngeal (thrush), persisting for >2 months in children aged >6 months
  • Cardiomyopathy
  • CMV infection, with onset before age 1 month
  • Diarrhea, recurrent or chronic
  • Hepatitis
  • HSV stomatitis, recurrent (more than two episodes within 1 year)
  • HSV bronchitis, pneumonitis, or esophagitis with onset before age 1 onth
  • Herpes zoster (shingles) involving at least two distinct episodes or more than one dermatome
  • Leiomyosarcoma
  • Lymphoid interstitial pneumonia or pulmonary lymphoid hyperplasia complex
  • Nephropathy
  • Nocardiosis
  • Persistent fever (lasting >1 month)
  • Toxoplasmosis, onset before age 1 month
  • Varicella, disseminated (complicated chickenpox)
AIDS-Defining Conditions
  • Bacterial infections, multiple or recurrenta
  • Candidiasis of bronchi, trachea, or lungs
  • Candidiasis of esophagus
  • Cervical cancer, invasive
  • Coccidioidomycosis, disseminated or extrapulmonary
  • Cryptococcosis, extrapulmonary
  • Cryptosporidiosis, chronic intestinal (>1-month duration)
  • CMV disease (other than liver, spleen, or lymph nodes), onset at age >1 month
  • CMV retinitis (with loss of vision)
  • Encephalopathy attributed to HIVb
  • HSV: chronic ulcers (>1-month duration) or bronchitis, pneumonitis, or esophagitis (onset at age >1 month)
  • Histoplasmosis, disseminated or extrapulmonary
  • Isosporiasis, chronic intestinal (>1-month 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, recurrentc
  • Progressive multifocal leukoencephalopathy
  • Salmonella septicemia, recurrent
  • Toxoplasmosis of brain, onset at age >1 month
  • Wasting syndrome attributed to HIVb

a Only among children aged <6 years.

b Suggested diagnostic criteria for these illnesses, which might be particularly important for HIV encephalopathy and HIV wasting syndrome, are described in the following references:

Centers for Disease Control and Prevention. 1994 Revised classification system for human immunodeficiency virus infection in children less than 13 years of age. MMWR. 1994;43(No. RR-12).

Centers for Disease Control and Prevention. 1993 Revised classification system for HIV infection and expanded surveillance case definition for AIDS among adolescents and adults. MMWR. 1992;41(No. RR-17).

c Only among adults, adolescents, and children aged ≥6 years.

Key: CMV = cytomegalovirus; HSV = herpes simplex virus

Modified from:

Centers for Disease Control and Prevention. 1994 revised classification system for human immunodeficiency virus infection in children less than 13 years of age. MMWR. 1994;43(No. RR-12).

Centers for Disease Control and Prevention: Revised Surveillance Case Definition for HIV Infection—United States, 2014. MMWR. 2014;63(No. RR-3):1-10.

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