Criteria for presumptive diagnosis of severe HIV disease:
  1. The child is confirmed as being HIV antibody-positive
AND
2a.

The infant is symptomatic with two or more of the following:

  • oral thrush
  • severe pneumonia
  • severe sepsis

OR

2b.

Diagnosis of any AIDS-indicator condition(s)a can be made

Other things that support the diagnosis of severe HIV disease in an HIV-seropositive infant include:
Recent HIV-related maternal death or advanced HIV disease
Child's %CD4+ < 20%
Confirmation the diagnosis of HIV infection as soon as possible.
a

AIDS indicator conditions include some but not all HIV paediatric clinical stage 4 conditions such as Pneumocystis pneumonia, cryptococcal meningitis, severe wasting or severe malnutrition, Kaposi sarcoma, extrapulmonary tuberculosis

As per IMCI definition:

  • Oral thrush: Creamy white to yellow soft small plaques on red or normally coloured mucosa which can often be scraped off (pseudomembranous), or red patches on tongue, palate or lining of mouth, usually painful or tender.
  • Severe pneumonia: Cough or difficult breathing in a child with chest indrawing, stridor or any of the IMCI general danger signs; i.e. lethargic or unconscious, not able to drink or breastfeed, vomiting, and presence or history of convulsions during current illness; responding to antibiotics.
  • Severe sepsis: Fever or low body temperature in a young infant with any severe sign, e.g. fast breathing, chest indrawing, bulging fontanelle, lethargy, reduced movement, not feeding or sucking breast milk, convulsions.
  • It is unclear how often CD4 is lowered in the above conditions in HIV-uninfected children

From: 6, Diagnosis of HIV infection in infants and children

Cover of Manual on Paediatric HIV Care and Treatment for District Hospitals
Manual on Paediatric HIV Care and Treatment for District Hospitals: Addendum to the Pocket Book of Hospital Care of Children.
Copyright © World Health Organization 2011.

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