US Govt Definition of Aids

The Official U.S. Government Definition Of "AIDS" (1993)

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AIDS or HIV (or both)

Just because you have HIV Disease (or are "HIV Positive"), you don't necessarily have the disease called AIDS.

AIDS -- acquired immunodeficiency syndrome -- is a U.S. government classification of HIV Disease. The government does two things with a person's AIDS classification --

• It affects how the government handles epidemic statistics.
• It defines who is able to get U.S. government assistance.

Everybody who has AIDS also has HIV Disease. But not everybody with HIV Disease is classified by the U.S. government as having AIDS.

This U.S. Government classification of AIDS has two parts --

1. T-cell count.

2. History of an AIDS-defining disease.

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T-cell Count

The term t-cell is the popular name of a cell in the immune system. A better term is CD4 because there are several flavors of t-cells and we need to restrict our discussion to only one kind of t-cell -- officially called "CD4+ T-lymphocytes."

The virus that causes AIDS attacks CD4 cells. The structure of a CD4 cell makes it the easiest target for the virus.

HIV invades your CD4 cells and uses them as a breeding ground for new virus particles. Eventually the CD4 cell is killed by the virus.

As the number of CD4 cells decreases, your risk of getting a severe disease -- or "opportunistic illness" -- increases.

Here are the three official categories of CD4 counts --

Category Classification CD4 Level 1 asymptomatic greater than or equal to 500 cells/mL 2 ARC 200-499 cells/uL 3 AIDS less than 200 cells/uL

Your disease classification -- asymptomatic, ARC, or AIDS -- is based on the lowest t-cell test you ever had. For example, if you once tested at 180 ... but then got a big boost from a new protease inhibitor ... you are still considered in Category 3.

Your category is the lowest category you have ever been in, not your current category.

There's more to it than CD4 tests. The next section is the official definition.

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The Definition Of AIDS

Category 1 (Asymptomatic HIV Disease)

You are in Category 1 only if you are asymptomatic (no symptoms) and have never had less then 500 CD4 cells.

If you have had any of the AIDS-defining diseases listed for categories 2 or 3, then you are not in this category.

If your t-cell count has ever dropped below 500, you are not at Category 1.

Category 2 (ARC)

You are in Category 2 if --

1. your T-cells have dropped below 500 but never below 200; and,
-- or --

2. you have never had any Category 3 diseases (see below) but have had at least one of the following defining illnesses --

o Bacillary angiomatosis

o Candidiasis, oropharyngeal (thrush)

o Candidiasis, vulvovaginal; persistent, frequent, or poorly responsive to therapy

o Cervical dysplasia (moderate or severe)/cervical carcinoma in situ

o Constitutional symptoms, such as fever (38.5 C) or diarrhea lasting greater than 1 month

o Hairy leukoplakia, oral

o Herpes zoster (shingles), involving at least two distinct episodes or more than one dermatome

o Idiopathic thrombocytopenic purpura

o Listeriosis

o Pelvic inflammatory disease, particularly if complicated by tubo-ovarian abscess

o Peripheral neuropathy

According to the U.S. government, Category 2 means the immune system shows some signs of damage but it isn't life-threatening.

Category 3 (AIDS)

You are in Category 3 (i.e., you have "AIDS") if --

1. your T-cells have dropped below 200;
-- or --

2. you have had at least one of the following defining illnesses --

o Candidiasis of bronchi, trachea, or lungs

o Candidiasis, esophageal

o Cervical cancer, invasive**

o Coccidioidomycosis, disseminated or extrapulmonary

o Cryptococcosis, extrapulmonary

o Cryptosporidiosis, chronic intestinal (greater than 1 month's duration)

o Cytomegalovirus disease (other than liver, spleen, or nodes)

o Cytomegalovirus retinitis (with loss of vision)

o Encephalopathy, HIV-related

o Herpes simplex: chronic ulcer(s) (greater than 1 month's duration); or bronchitis, pneumonitis, or esophagitis

o Histoplasmosis, disseminated or extrapulmonary

o Isosporiasis, chronic intestinal (greater than 1 month's duration)

o Kaposi's sarcoma

o Lymphoma, Burkitt's (or equivalent term)

o Lymphoma, immunoblastic (or equivalent term)

o Lymphoma, primary, of brain

o Mycobacterium avium complex or M. kansasii, disseminated or extrapulmonary

o Mycobacterium tuberculosis, any site (pulmonary** or extrapulmonary)

o Mycobacterium, other species or unidentified species, disseminated or extrapulmonary

o Pneumocystis carinii pneumonia

o Pneumonia, recurrent**

o Progressive multifocal leukoencephalopathy

o Salmonella septicemia, recurrent

o Toxoplasmosis of brain

o Wasting syndrome due to HIV

** Added in the 1993 expansion of the AIDS surveillance case definition.

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