The Staging Classification developed at Walter Reed Hospital divides HIV-infected patients into 7 stages based on immune and infectious conditions. In addition, certain clinical findings are indicated by special designations.
Staging
|
Parameters |
WR 0 |
WR 1 |
WR 2 |
|
HIV antibody and/or virus isolation |
no |
yes |
yes |
|
chronic lymphadenopathy |
no |
no |
yes |
|
CD4 lymphocytes per µL |
>= 400 |
>= 400 |
>= 400 |
|
delayed hypersensitivity |
normal |
normal |
normal |
|
oral thrush |
no |
no |
no |
|
opportunistic infections |
no |
no |
no |
|
Parameters |
WR 3 |
WR 4 |
WR 5 |
WR 6 |
|
HIV antibody and/or virus isolation |
yes |
yes |
yes |
yes |
|
chronic lymphadenopathy |
variable |
variable |
variable |
variable |
|
CD4 lymphocytes per µL |
< 400 |
< 400 |
< 400 |
< 400 |
|
delayed hypersensitivity |
normal |
partial |
complete anergy +/- thrush |
partial or complete anergy |
|
oral thrush |
no |
no |
present +/- anergy |
variable |
|
opportunistic infections |
no |
no |
no |
yes |
Chronic lymphadenopathy (generalized lymphadenopathy)
(1) presence of lymph nodes in 2 or more extra-inguinal sites
(2) nodes measure at least 1 cm in diameter
(3) lymphadenopathy persists for more than 3 months
Delayed hypersensitivity:
(1) anergens placed: tetanus, Trichophyton, mumps and Candida
(2) normal: reactive to 2 or more anergens
(3) partial anergy: reactive to only 1 anergen
(4) complete anergy: no reaction to any of the tested anergens
Opportunistic infections:
(1) Pneumocystis carinii pneumonia
(2) central nervous system or disseminated toxoplasmosis
(3) chronic cryptosporidiosis
(4) candida esophagitis
(5) disseminated histoplasmosis
(6) central nervous system or dissemination cryptococcosis
(7) disseminated atypical mycobacterial infection
(8) extrapulmonary tuberculosis
(9) disseminated nocardiosis
(10) disseminated cytomegalovirus infection
(11) chronic mucocutaneous herpes simplex
Subdesignations
|
B |
(1) temperature > 38°C for 3 weeks (2) unexplained loss of > 10% of body weight over a period of 3 months (3) night sweats for 3 weeks (4) chronic diarrhea for more than 1 month |
|
K |
Kaposi's sarcoma |
|
CNS |
neurologic disease (demyelinating disease, encephalopathy, neuropathy) secondary to infection of the central nervous system due to HIV infection itself |
Limitations:
• The staging classification is of only limited usefulness in predicting which patients will progress to AIDS. The most important predictor for progression to AIDS is a low CD4 lymphocyte count, with skin test anergy predictive in those with low CD4 counts.
• Not all patients can be placed in a satisfactory stage.
• It does not include malignancies related to HIV infection other than Kaposi's sarcoma.
Specialty: Infectious Diseases
ICD-10: ,
