Confronting AIDS Update 1988 (1988) / Chapter Skim
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Appendix B: CDC Classification System for HIV Infections and Revised Case Definition for AIDS
Appendix B: CDC Classification System for HIV Infections and Revised Case Definition for AIDS
Pages 202-217
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From page 202... ...
LZ Cooper, MD, St Luke's-Roosevelt Hospital Center, New York City; JP Davis, MD, State Epidemiologist, Wisconsin Division of Health; MA Fischl, MD, University of Miami School of Medicine, Miami, Florida; G Friedland, MD, Albert Einstein College of Medicine, New York City; MA Johnson, MD, Dl Abrams, MD, San Francisco General Hospital; D Mildvan, MD, Beth Israel Medical Center, New York City; CU Tuazon, MD, George Washington University School of Medicine, Washington, DC; RW Price, MD, Memorial Sloan-Kettering Cancer Center, New York City; C Konigsberg, MD, Broward County Public Health Unit, Fort Lauderdale, Florida; MS Gottlieb, MD, University of California—Los Angeles Medical Center; representatives of the National Institute of Allergy and Infectious Diseases, National Cancer Institute, National Institutes of Health, Center for Infectious Diseases, CDC. SOURCE: Reprinted from Morbidity and Mortality Weekly Report 35 (May 23, 1986)
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Secondary infectious diseases Category C-1. Specified secondary infectious diseases listed in the CDC surveillance definition for AlDSt Category C-2.
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Group IV includes patients with clinical symptoms and signs of HTLV-111/LAV infection other than or in addition to Iymphadenopathy. Patients in this group are assigned to one or more subgroups based on clinical findings.
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Includes patients with symptomatic or invasive disease due to one of 1 2 specified secondary infectious diseases listed in the surveillance definition of AIDS§: Pneumocystis carinii pneumonia, chronic cryptosporidiosis, toxoplasmosis, extraintestinal strongyloidiasis, isosporiasis, candidiasis (esophageal, bronchial, or pulmonary) , cryptococcosis, histoplasmosis, mycobacterial infection with Mycobacterium avium comple% or M kansasi`, cytomegalovirus infection, chronic mucocutaneous or disseminated herpes simplex virus infection, and progressive multifocal leukoencephalopathy.
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Sarngadharan MG, Groopman JE, et aL Seroepidemiological studies of human Tlymphotropic retrovirus type 111 in acquired immunodeficiency syndrome. Lancet 1984;1:1438-40.
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to increase the sensitivity and specificity of the definition through greater diagnostic application of laboratory evidence for HIV infection; and d) to be consistent with current diagnostic practice, which in some cases includes presumptive, i.e., without confirmatory laboratory evidence, diagnosis of AlDS-indicative diseases (e.g., Pneumocystis carinii pneumonia, Kaposi's sarcoma)
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immunodeficiency syndrome or an acquired immunodeficiency syndrome atypical of HIV infection, such as one involving hypogammaglobulinemia B Indicator diseases diagnosed definitively (See Appendix II)
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immunoblastic sarcoma (equivalent to any of the following, although not necessarily all in combination: immunoblastic Iymphoma, largecell Iymphoma, diffuse histiocytic Iymphoma, diffuse undifferentiated Iymphoma, or high-grade Iymphoma) (See Appendix IV for equivalent terms and numeric codes used in the International Classification of Diseases, Ninth Revision, Clinical Modification)
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toxoplasmosis of the brain affecting a patient >1 month of age 111. With Laboratory Evidence Against HIV Infection With laboratory test results negative for HIV infection (See Appendix b, a diagnosis of AIDS for surveillance purposes is ruled out unless: A
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Likewise, the definition accepts a reactive screening test for HIV antibody without confirmation by a supplemental test because a repeatedly reactive screening test result, in combination with an indicator disease, is highly indicative of true HIV disease. For national surveillance purposes, the tiny proportion of possibly false-positive screening tests in persons with AIDSindicative diseases is of little consequence.
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, . ~ , __ @lY Is the T-helper lymphocyte count <400/mm3 ?
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APPENDIX I Laboratory Evidence For or Against HIV Infection For Infection: When a patient has disease consistent with AIDS: a. a serum specimen from a patient ~15 months of age, or from a child <15 months of age whose mother is not thought to have had HIV infection during the child's perinatal period, that is repeatedly reactive for HIV antibody by a screening test (e.g., enzyme-linked immunosorbent assay [ELISA]
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a serum specimen from a child < 15 months of age, whose mother is thought to have had HIV infection during the child's perinatal period, that is repeatedly reactive for HIV antibody by a screening test, even if positive by a supplemental test, without additional evidence for immunodeficiency as described above (in 1.b) and without a positive HIV culture or serum antigen test, if done.
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recent onset of retrosternal pain on swallowing; AND b. oral candidiasis diagnosed by the gross appearance of white patches or plaques on an erythematous base or by the microscopic appearance of fungal mycelial filaments in an uncultured specimen scraped from the oral mucosa.
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recent onset of a focal necrologic abnormality consis of the brain tent with intracranial disease or a reduced level of con sciousness; AND b. brain imaging evidence of a lesion having a mass ef fect (on computed tomography or nuclear magnetic resonance)
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: histiocytic (diffuse) reticulum cell sarcoma: pleomorphic cell type or not otherwise specified Burkitt's tumor or Iymphoma malignant Iymphoma, Burkitt's type ICD-O (Oncologic Histologic Types 19761 Terms Malignant Iymphoma, undifferentiated cell type non-Burkitt's or not otherwise specified Malignant Iymphoma, stem cell type stem cell Iymphoma Malignant Iymphoma, immunoblastic type immunoblastic sarcoma, immunoblastic Iymphoma, or immunoblastic Iymphosarcoma Malignant Iymphoma, centroblastic type diffuse or not otherwise specified, or germinoblastic sarcoma: diffuse or not otherwise specified Malignant Iymphoma, follicular center cell, non-cleaved diffuse or not otherwise specified Reticulosarcoma, not otherwise specified malignant Iymphoma, histiocytic: diffuse or not otherwise specified reticulum cell sarcoma, not otherwise specified malignant Iymphoma, reticulum cell type Reticulosarcoma, pleomorphic cell type malignant Iymphoma, histiocytic, pleomorphic cell type reticulum cell sarcoma, pleomorphic cell type Burkitt's Iymphoma or Burkitt's tumor malignant Iymphoma, undifferentiated, Burkitt's type malignant Iymphoma, Iymphoblastic, Burkitt's type
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