9.8. HIV/AIDS

Updated 3 October 2025

Standard Operating Procedure for Surveillance of Human Immunodeficiency Virus (HIV) Infection and Acquired Immunodeficiency Syndrome (AIDS)

 

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Version: 1.0

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Definition 

A

Tested / reflects current policy and updates

B

Possible gaps / may not reflect latest policies and updates / users need to apply due diligence

C

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D

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HUMAN IMMUNODEFICIENCY VIRUS (HIV) INFECTION AND ACQUIRED IMMUNODEFICIENCY SYNDROME (AIDS).  CLASS 3

 

Internationally notifiable:

Yes

Reporting interval:

Monthly to National Authorities

 

Annually to CARPHA

Report to (country level):

National Epidemiologist or National AIDS

 

Programme Coordinator as is relevant

Report to (regional level):

CARPHA’s Epidemiology Division (HCE)

 

Overview

A case of HIV infection is defined as an individual with HIV infection confirmed by laboratory criteria, irrespective of clinical stage (including severe or stage 4 clinical disease, which is also known as AIDS). 

AIDS is a constellation of symptoms, signs and illnesses resulting from a compromised immune system following infection with human immunodeficiency virus (HIV) in the absence of other known causes of immunosuppression. 

HIV is found in blood, semen, vaginal and rectal secretions or breast milk of an infected person. For infection to occur the virus must be introduced through broken skin including via injection, via the placenta or come in contact with mucous membranes.

There is no risk of transmission during routine social contact with an HIV infected person.

 

Established modes of transmission include:

  • Unprotected sexual contact (heterosexual or homosexual); in rare cases oral sex with an HIV infected person.
  • Perinatal transmission from an HIV infected mother to a foetus or new-born
  • HIV infected mother breastfeeding
  • Transfusion of HIV infected blood or blood products
  • Sharing HIV-contaminated needles
  • Needle stick injuries especially in healthcare settings

 

Antiretroviral therapy (ART) effectively suppresses HIV in the body and reduces the chance of a person living with HIV transmitting the disease to another.

 

Surveillance Procedures: 

Step 1: Case Detection/ Laboratory Confirmation and Reporting – Healthcare Providers / Laboratory Personnel 

 

Immediately report all confirmed cases to the STI unit. (Note (Healthcare Providers): Patient notes should be submitted to STI unit as needed for proper follow up.) 

 

Case definition (WHO, 2007)

HIV infection:

Adults and children 18 months or older

The diagnosis of HIV infection is based on: A positive HIV antibody test (rapid or laboratory-based enzyme immunoassay) that is confirmed by a second HIV antibody test (rapid or laboratory-based enzyme immunoassay) relying on different antigens or on different operating characteristics; 

and/or; 

A positive virological test for HIV or its components (HIV-RNA or HIV-DNA or HIV p24 antigen), that is confirmed by a second virological test obtained from a separate sample.

 

Children younger than 18 months: 

A diagnosis of HIV infection is based on: A positive virological test for HIV or its components (HIV-RNA or HIV-DNA or HIV p24 antigen), that is confirmed by a second virological test obtained from a separate sample taken more than four weeks after birth.

Note: Because of the possible presence of the mother’s antibodies circulating in the infant’s blood, HIV antibody testing is not recommended for definitive or confirmatory diagnosis of HIV infection in children until 18 months of age.

 

Advanced HIV infection (including AIDS):

Clinical criteria for diagnosis of advanced HIV in adults and children with confirmed HIV infection:

  • Diagnosis (whether presumptive or definitive) of any stage 3 or stage 4 condition (Tables 12 and 13).

AND/OR;

Immunological criteria for diagnosing advanced HIV in adults and children five years or older with confirmed HIV infection:

  • A CD4 count less than 350 per mm3 of blood in an HIV-infected adult or child (Table 3).

AND/OR;

Immunological criteria for diagnosing advanced HIV in a child younger than five years of age with confirmed HIV infection (Table 14):

  • Children younger than 12 months; % CD4+ < 30
  • Children aged 12–35 months; % CD4+ < 25
  • Children aged 36–59 months; % CD4+ < 20

 

AIDS:

AIDS in adults and children is defined as:

  • A presumptive or definitive clinical diagnosis of any stage 4 condition (Table 1) with confirmed HIV infection, OR 
  • An immunological diagnosis in adults and children with confirmed HIV infection and > 5 years of age; first ever documented CD4 count less than 200 per mm3 or % CD4+ < 15, OR 
  • Among children aged 12–35 months with confirmed HIV infection; first ever documented % CD4 < 20, OR 
  • Among children less than 12 months of age and with confirmed HIV infection; first ever documented % CD4 < 25.

 

Note: In cases where laboratory confirmation of HIV infection cannot be obtained, a case of AIDS may be reported on its clinical presentation.

 

Clinical criteria for presumptive diagnosis of severe HIV disease among infants and children aged less than 18 months in situations where virological testing is not available (WHO)

 

A presumptive diagnosis of severe HIV disease should be made if:

  • the infant is confirmed as HIV antibody-positive;

AND

  • diagnosis of any AIDS-indicator condition(s) can be made;

OR

  • the infant is symptomatic with two or more of the following;
    • oral thrush
    • severe pneumonia
    • severe sepsis

 

Other factors that support the diagnosis of severe HIV disease in an HIV seropositive infant include:

  • recent HIV related maternal death or advanced HIV disease in the mother;
  • CD4 < 20%.

 

Confirmation of the diagnosis of HIV infection should be sought as soon as possible.

 

Table 1. WHO clinical staging of HIV/AIDS for adults and adolescents with confirmed HIV infection

Clinical stage

Condition

1

Asymptomatic

Persistent generalized lymphadenopathy

2

Moderate unexplained weight loss (<10% of presumed or measured body weight)

Recurrent respiratory tract infections sinusitis, tonsillitis, otitis media and pharyngitis)

Herpes zoster

Angular cheilitis

Recurrent oral ulceration

Papular pruritic eruptions

Seborrhoeic dermatitis

Fungal nail infections

3

Unexplained severe weight loss (>10% of presumed or measured body weight)

Unexplained chronic diarrhoea for longer than one month

Unexplained persistent fever (above 37.6°C intermittent or constant, for longer than one month)

Persistent oral candidiasis

Oral hairy leukoplakia

Pulmonary tuberculosis (current)

Severe bacterial infections (such as pneumonia, empyema, pyomyositis, bone or joint infection, meningitis or bacteraemia)

Acute necrotizing ulcerative stomatitis, gingivitis or periodontitis

Unexplained anaemia (<8 g/dl), neutropoenia (<0.5 × 109 per litre) or chronic thrombocytopaenia (<50 × 109 per litre)

4

HIV wasting syndrome

Pneumocystis pneumonia

Recurrent severe bacterial pneumonia

Chronic herpes simplex infection (orolabial, genital or anorectal of more than one month’s duration or visceral at any site)

Oesophageal candidiasis (or candidiasis of trachea, bronchi or lungs)

Extrapulmonary tuberculosis

Kaposi’s sarcoma

Cytomegalovirus infection (retinitis or infection of other organs)

Central nervous system toxoplasmosis

HIV encephalopathy

Extrapulmonary cryptococcosis including meningitis

Disseminated non-tuberculous mycobacterial infection

Progressive multifocal leukoencephalopathy

Chronic cryptosporidiosis (with diarrhoea)

Chronic isosporiasis

Disseminated mycosis (coccidiomycosis or histoplasmosis)

Recurrent non-typhoidal Salmonella bacteraemia

Lymphoma (cerebral or B-cell non-Hodgkin) or other solid HIV-associated tumours

Invasive cervical carcinoma

Atypical disseminated leishmaniasis

Symptomatic HIV-associated nephropathy or symptomatic HIV-associated cardiomyopathy

 

Table 2. WHO clinical staging of HIV/AIDS for children with confirmed HIV infection

Clinical stage

Condition

1

Asymptomatic

Persistent generalized lymphadenopathy

2

Unexplained persistent hepatosplenomegaly

Papular pruritic eruptions

Fungal nail infection

Angular cheilitis

Lineal gingival erythema

Extensive wart virus infection

Extensive molluscum contagiosum

Recurrent oral ulcerations

Unexplained persistent parotid enlargement

Herpes zoster

Recurrent or chronic upper respiratory tract infections (otitis media, otorrhoea, sinusitis or tonsillitis)

3

Unexplained moderate malnutrition or wasting not adequately responding to standard therapy

Unexplained persistent diarrhoea (14 days or more)

Unexplained persistent fever (above 37.5°C intermittent or constant, for longer than one month)

Persistent oral candidiasis (after first 6–8 weeks of life)

Oral hairy leukoplakia

Acute necrotizing ulcerative gingivitis or periodontitis

Lymph node tuberculosis

Pulmonary tuberculosis

Severe recurrent bacterial pneumonia

Symptomatic lymphoid interstitial pneumonitis

Chronic HIV-associated lung disease including bronchiectasis

Unexplained anaemia (<8 g/dl), neutropoenia (<0.5 × 109 per litre) and or chronic thrombocytopaenia (<50 × 109 per litre)

4

Unexplained severe wasting, stunting or severe malnutrition not responding to standard therapy

Pneumocystis pneumonia

Recurrent severe bacterial infections (such as empyema, pyomyositis, bone or joint infection or meningitis but excluding pneumonia)

Chronic herpes simplex infection (orolabial or cutaneous of more than one month’s duration or visceral at any site)

Oesophageal candidiasis (or candidiasis of trachea, bronchi or lungs)

Extrapulmonary tuberculosis

Kaposi sarcoma

Cytomegalovirus infection: retinitis or cytomegalovirus infection affecting another organ, with onset at age older than one month

Central nervous system toxoplasmosis (after one month of life)

Extrapulmonary cryptococcosis (including meningitis)

HIV encephalopathy

Disseminated endemic mycosis (coccidiomycosis or histoplasmosis)

Disseminated non-tuberculous mycobacterial infection

Chronic cryptosporidiosis (with diarrhoea)

Chronic isosporiasis

Cerebral or B-cell non-Hodgkin lymphoma

Progressive multifocal leukoencephalopathy

Symptomatic HIV-associated nephropathy or HIV-associated cardiomyopathy

 

Table 3. WHO immunological classification for established HIV infection

 

HIV-associated

immunodeficiency

Age-related CD4 values

<11

months

(% CD4+)

12–35

months

(% CD4+)

36 –59

months

(% CD4+)

>5 years

(absolute

number

per mm3 or

% CD4+)

None or not significant

> 35

> 30

> 25

> 500

Mild

30 – 35

25 – 30

20 – 25

350 – 499

Advanced

25 – 29

20 – 24

15 – 19

200 – 349

Severe

< 25

< 20 

< 15

< 200 or <15%

 

Step 2: STI unit should share data to the Epidemiology unit without identifiers (as per country guidelines) 

 

Step 3: Data Management (Epi Unit) 

  • Data should be cleaned and analysed 
  • Preparation of a report should be done on the evolution of the epidemiological situation of the disease 
  • Dissemination of a periodic situation report 

 

Notes: 

Control and prevention

  • The public should be educated about HIV and AIDS and on the modes of transmission.
  • Individuals should be encouraged to know their HIV status and less risky sexual behaviours should be promoted.
  • The use of male and/or female condoms consistently and correctly should be promoted
  • HIV-negative people in serodiscordant relationships and those who engage in risky sexual practices should be placed on pre-exposure prophylaxis for HIV (PrEP) to prevent HIV transmission.
  • People living with HIV should be placed on ART to reduce viral load to undetectable levels