Table 5 Presumptive and definitive criteria for AIDS-defining events
| Â | Presumptive criteria | Definitive criteria |
|---|---|---|
Constitutional disease | Â | Â |
HIV wasting syndrome | Unexplained involuntary weight loss >10% from baseline PLUS persistent diarrhoea with ≥2 liquid stools/day for >1 month OR chronic weakness OR persistent fever >1 month. Should exclude other causes such as cancer, TB, MAC, cryptosporidiosis or other specific enteritis |  |
Infections | Â | Â |
Aspergillosis, other invasive | CXR abnormality compatible with aspergillosis PLUS invasive mycelia consistent with Aspergillus on lung biopsy or positive culture of lung tissue or positive culture of sputum | CXR abnormality compatible with aspergillosis PLUS invasive mycelia consistent with Aspergillus on lung biopsy PLUS positive culture of lung tissue or positive culture of sputum |
Bartonellosis | Clinical evidence of bacillary angiomatosis or bacillary peliosis PLUS positive silver stain for bacilli from skin lesion or affected organ | Clinical evidence of bacillary angiomatosis or bacillary peliosis PLUS positive culture or PCR for Bartonella quintana or Bartonella henselae |
Candidiasis of bronchi, trachea or lungs | None | Macroscopic appearance at bronchoscopy or histology or cytology (not culture) |
Candidiasis, oesophageal | Recent onset retrosternal pain on swallowing PLUS clinical diagnosis or oral candidiasis by cytology (not culture) PLUS clinical response to treatment | Macroscopic appearance at endoscopy or histology or cytology (not culture) |
Coccidiodomycosis, disseminated or extrapulmonary | None | Histology or cytology, culture or antigen detection from affected tissue |
Cryptococcosis, meningitis or pulmonary | None | Histology or cytology/microscopy, culture or antigen detection from affected tissue |
Cryptosporidiosis | None | Persistent diarrhoea >1Â month, histology or microscopy |
CMV retinitis | Typical appearance on fundoscopy of discrete patches of retinal whitening, associated with vasculitis, haemorrhage, and necrosis, confirmed by ophthalmologist | None |
CMV end-organ disease | None | Compatible symptoms plus histology or detection of antigen from affected tissue |
Infections | Presumptive criteria | Definitive criteria |
CMV radiculomyelitis | Leg weakness and decreased reflexes or syndrome consistent with cord lesion presenting subacutely over days to weeks. CT/MRI shows no mass lesion. CSF shows >5 WBC with >50% polymorphs and positive CMV PCR, antigen or culture | None |
CMV meningoencephalitis | Rapid (days to <4 weeks) syndrome with progressive delirium, cognitive impairment, ± seizures and fever (often with CMV disease elsewhere) CT/MRI may show periventricular abnormalities. | Rapid (days to <4 weeks) syndrome with progressive delirium, cognitive impairment, ± seizures and fever (often with CMV disease elsewhere) CT/MRI may show periventricular abnormalities and CSF PCR positive for CMV |
HSV mucocutaneous ulceration | None | Persistent ulceration for >1Â month, plus histology or culture or detection of antigen or HSV PCR positive from affected tissue |
HSV visceral disease (for example, oesophagitis, pneumonitis | None | Symptoms, plus histology or culture or detection of antigen or HSV PCR positive from affected tissue |
VZV multidermatomal | ≥10 typical ulcerated lesions affecting at least two noncontiguous dermatomes plus response to an antiviral active against VZV unless resistance is demonstrated | ≥10 typical ulcerated lesions affecting at least two noncontiguous dermatomes plus culture or detection of antigen or VZV PCR-positive from affected tissue |
Histoplasmosis, disseminated or extrapulmonary | None | Symptoms plus histology or culture or detection of antigen from affected tissues |
Isosporiasis | None | Persistent diarrhoea for >1Â month, histology or microscopy |
Leishmaniasis, visceral | None | Symptoms plus histology |
Microsporidiosis | None | Persistent diarrhoea for >1Â month, histology or microscopy |
MAC, and other atypical mycobacteriosis | Symptoms of fever, fatigue, anaemia or diarrhoea plus acid-fast bacilli seen in stool, blood, body fluid, or tissue but not grown on culture and no concurrent diagnosis of TB except pulmonary | Symptoms of fever, fatigue, anaemia or diarrhoea plus culture from stool, blood, body fluid, or tissue |
Tuberculosis, pulmonary | Symptoms of fever, dyspnoea, cough, weight loss, fatigue plus acid-fast bacilli seen in sputum, lavage, or lung tissue, not grown in culture, plus responds to standard TB treatment | Symptoms of fever, dyspnoea, cough, weight loss, fatigue plus positive TB culture or PCR from sputum, bronchial lavage, or lung tissue |
Tuberculosis, extrapulmonary | Symptoms, plus acid-fast bacilli seen from affected tissue or blood but not grown in culture, concurrent diagnosis of pulmonary TB or responds to standard TB treatment | Symptoms, plus positive TB culture or PCR from affected tissue |
Nocardiosis | Clinical evidence of invasive infection plus microscopic evidence of branching, Gram-positive, weakly acid-fast bacilli from affected tissue | Clinical evidence of invasive infection plus positive culture from blood or affected tissue |
Penicillium marneffei disseminated | Characteristic skin lesions plus response to antifungal therapy for penicilliosis (in an endemic area) | Culture from a nonpulmonary site |
Pneumocystis pneumonia (PCP) | Symptoms, any CXR appearance and CD4 count <200, negative bronchoscopy if treated for PCP for >7Â days, no bacterial pathogens in sputum, and responds to PCP treatment | Microscopy or histology |
Extrapulmonary pneumocystis | None | Symptoms plus microscopy or histology |
Recurrent bacterial pneumonia | Second pneumonic episode within 1Â year, new CXR appearance, symptoms and signs, diagnosed by a doctor | Second pneumonic episode within 1Â year, new CXR appearance, detection of a pathogen |
Progressive multifocal leukoencephalopathy (PML) | Symptoms and brain scan consistent with PML and no response to treatment for toxoplasmosis | Symptoms and brain scan consistent with PML and positive JC virus PCR in CSF or histology |
Rhodococcus equi disease | None | Clinical evidence of invasive infection plus culture of organism from blood or affected tissue |
Recurrent Salmonella septicaemia | None | Second distinct episode, culture confirmed |
Cerebral toxoplasmosis | Symptoms of focal intracranial abnormality or decreased consciousness, and brain scan consistent with lesion(s) having mass effect or enhancing with contrast, and either positive toxoplasma serology or response to treatment clinically and by scan | Histology or microscopy |
Extra-cerebral toxoplasmosis | None | Symptoms plus histology or microscopy |
Neoplasms | Â | Â |
Kaposi sarcoma (KS) | Typical appearance without resolution. Diagnosis should be made by an experienced HIV clinician | Histology |
Cervical carcinoma, invasive | None | Histology |
Lymphoma, primary cerebral | Symptoms consistent with lymphoma, at least one lesion with mass effect on brain scan, no response to toxoplasma treatment clinically and by scan | Histology |
Lymphoma, non-Hodgkin B cell | None | Histology |
lymphoma, Hodgkin | None | Histology |
Neurologic | Â | Â |
HIV encephalopathy | Cognitive or motor function interfering with usual activity, progressive over weeks or months in the absence of another condition to explain the findings. Should have a brain scan ± CSF examination to exclude other causes. | None |
Other | Â | Â |
Indeterminate cerebral lesion (s) | Neurologic illness, with evidence for an intracerebral lesion by brain scan, where the differential diagnosis is either cerebral toxoplasmosis. PML, cerebral lymphoma, or HIV encephalopathy | Â |