Annotations:

a) The purpose is to help the health care provider to recognize the patient with symptomatic HIV infection, as an aid to clinical management. HIV testing, when available and affordable, can be used to substantiate the clinical diagnosis.

b) Cardinal Findings:

• Kaposi sarcoma (1)
  

• Pneumocystis carinii pneumonia
  

• Toxoplasma encephalitis
  

• Oesophageal candidiasis
  

• Cytomegalovirus retinitis
  

c) Characteristic Findings (2):

• Oral thrush (in patient not taking antibiotics)
  

• Hairy leukoplakia

• Cryptococcal meningitis (may be a cardinal finding in Africa)
  

• Miliary, extrapulmonary or noncavitary pulmonary tuberculosis (3)
  

• Herpes zoster, present or past, particularly multidermatomal, age 50 years
  

• Severe prurigo
  

• Kaposi sarcoma (other than as cardinal finding)
  

• High-grade B-cell extranodal lymphoma
  

d) Associated Findings (2):

• Weight loss (recent unexplained) of more than 10% of baseline body weight, if

• assessable (3)
  

• Fever (continuous or intermittent) for more than 1 month (3)
  

• Diarrhoea (continuous or intermittent) for more than 1 month

• Ulcers (genital or perianal) for more than 1 month
  

• Cough for more than 1 month (3)
  

• Neurological complaints or findings (4)
  

• Generalised lymphadenopathy (extrainguinal)
  

• Drug reactions (previously not seen), e. g. to thiacetazone or sulfonamides
  

• Skin infections (severe or recurrent), e. g. warts, dermatophytes, folliculitis
  

e) Epidemiological Risk Factors:

• Present or past high-risk behaviour:
  -- drug injecting
  -- multiple sex partners
  -- sex partner(s) with known AIDS or HIV infection
  -- sex partner(s) with known epidemiological risk factor or from an area with a high prevalence of HIV infection
  -- males having penetrative sexual intercourse with males
  

• Recent history of genital ulcer disease.
  

• History of transfusion after 1975 of unscreened blood, plasma or clotting factor; or (even if screened) from an area with a high prevalence of HIV infection.
  

• History of scarification, tattooing, ear piercing or circumcision using non-sterile instruments.
   

1. Kaposi sarcoma is a cardinal finding only when: (i) intraoral lesions are present; (ii) lesions are generalised; or (iii) lesions are rapidly progressive or invasive.

2. If no other obvious cause of immunosuppression is evident.

3. The combination of fever, weight loss and cough is characteristic of both tuberculosis and AIDS.

4. Neurological complaints or findings associated with HIV infection include seizures (especially focal), peripheral neuropathy (motor or sensory), focal central motor or sensory deficits, dementia and progressively worsening headache.

Adapted from WHO/ GPA/ IDS/ HCS/ 91.6 "Guidelines for the Clinical Management of HIV Infection in Adults", December 1991.