Module 5: Management Of Employees With HIV/AIDS At Primary Level - Staging

CLINICAL STAGING:

Why use staging?

The following refers to WHO or CDC Staging:

• Allows clinical evaluation of immune function.
• Rapid progressors: Rapid decline in immune function -Develop AIDS in 1 to 2 years - small proportion.
• Intermediate progressors: Steady decline in immune function - majority.
• Slow progressors: Able to control HIV RNA load for long time - small proportion .

As far as staging and immune function are concerned, We use the WHO classification as it is simpler. The following graph shows how the WHO staging relates to immune function:

WHO staging:

• Outline of the WHO classification.
• What we commonly see in Khayelitsha in each stage? (primary care, non-specialist setting).
• Nurse-based with medical officer back-up.

WHO Stage 1:

• Seroconversion.
• Non-specific viral illness (fever, malaise).
• May get persistent generalised lymphadenopathy.
• Not often seen.

WHO Stage 2:

• Usually asymptomatic .
• Herpes zoster - "herald sign" in young person in Africa.
• Minor mucocutaneous lesions (mouth).
• Recurrent respiratory tract infections.

WHO Stage 3:

• Pulmonary TB.
• Oral or recurrent vaginal candida.
• Chronic diarrhoea.
• Bacterial and fungal skin infections.
• Herpes simplex viral infections - genital (that heal in less than 1 month).

WHO Stage 4:

• Extra-pulmonary TB (commonly, pleura (effusions), lymph nodes, abdomen)
• HIV wasting syndrome
• Oesophageal candidiasis
• Chronic diarrhoea
• Chronic Herpes simplex ulcers
• Pneumocystis carinii pneumonia
• Cryptococcal meningitis.