Appendix

The full definition of AIDS (CDC Sept. 1987)

A case of AIDS is defined as an illness characterized by one or more of the following "indicator" diseases, depending on the status of laboratory evidence for HIV infection.

I    Without laboratory evidence regarding HIV infection:

If laboratory tests for HIV were not performed or gave indeterminate results any of the conditions on the list below would indicate AIDS if it was diagnosed by a definitive method and the patient had none of the other causes of immunodeficiency listed below that could explain the occurrence of the indicator disease:

1.    Pneumocystis carinii pneumonia.
2.    Toxoplasmosis of the brain in a patient > 1 month of age.
3.    Cryptosporidiosis with diarrhoea persisting for > 1 month.
4.    Candidiasis of the oesophagus, trachea, bronchi or lungs.
5.    Extrapulmonary cryptococcosis.
6.    Mycobacterium avium-complex or M. kansasii disease at a site other than lungs or lymph nodes.
7.    Cytomegalovirus infection of an internal organ other than liver in a patient > 1 month of age.
8.    Herpes simplex virus infection causing a mucocutaneous ulcer that persists for more than 1 month, or bronchitis, pneumonitis, or oesophagitis for any duration in a patient > 1 month of age.
9.    Progressive multifocal leucoencephalopathy.
10.    Primary lymphoma of the brain in a patient < 60 years of age.
11.    Kaposi's sarcoma in a patient < 60 years of age.
12.    PLH/LIP complex (pulmonary lymphoid hyperplasia and/or lymphoid interstitial pneumonia) in a child < 13 years of age.

Causes of immunodeficiency that disqualify diseases as indicators of AIDS in the absence of antibody evidence for HIV infection.

a. High-dose or long-term systemic corticosteriod therapy or other immunosuppressive/ cytotoxic therapy within three months before the onset of the indicator disease.
b. Hodgkin's disease, non-Hodgkin's lymphoma (other than primary brain lymphoma), lymphocytic leukaemia, multiple myeloma, or another cancer of lymphoreticular or histiocytic tissue, or angioimmunoblastic lymphadenopathy, diagnosed before or within three months after diagnosis of the indicator disease.
c. A genetic (congenital) immunodeficiency syndrome or an acquired immunodeficiency. syndrome atypical of HIV infection such as one involving hypogammaglobulinaemia.

II    With laboratory evidence for HIV infection:

In the presence of antibody evidence for HIV infection.

Any of the conditions listed above or below indicates AIDS regardless of the presence of other causes of immunodeficiency.

A. Diseases diagnosed definitively.
13.    Isosporiasis with diarrhoea persisting >1 month.
14.    Extrapulmonary or disseminated histoplasmosis.
15.    Extrapulmonary or disseminated coccidioidomycosis.
16.    Extrapulmonary or disseminated tuberculosis.
17.    Any noncutaneous extrapulmonary or disseminated mycobacterial infection other than tuberculosis or leprosy.
18.    Recurrent non-typhoid Salmonella septicaemia.
19.    Multiple or recurrent bacterial infections (any combination of > 2 within a two year period) of the following types in a child < 13 years of age:

septicaemia, pneumonia, meningitis, bone or joint infection, or abscess of an internal organ or body cavity (excluding otitis media or superficial skin or mucosal abscesses caused by Haemophilus, Streptococcus (including pneumococcus), or other pyogenic bacteria).

20.    Kaposi's sarcoma at any age.
21.    Primary lymphoma of the brain at any age.
22.    Other non-Hodgkin's lymphoma of B-cell immunologic phenotype:

small noncleaved lymphoma (Burkitt's tumour or Burkitt-like lymphoma) or immunoblastic sarcoma (large cell lymphoma, diffuse histiocytic lymphoma, diffuse undifferentiated lymphoma, reticulum cell sarcoma, or high-grade lymphoma).

Note: Lymphomas are not included if they are of T-cell immunological phenotype or are described as `lymphocytic', `Iymphoblastic', `small cleaved' or `plasmacytoid lymphocytic'.

23.    HIV encephalopathy (`AIDS demential complex')*
24.    HIV wasting syndrome (`slim disease')**

B.    Diseases diagnosed presumptively

•    Pneumocystis carinii pneumonia
•    Toxoplasmosis of the brain in a patient > 1 month of age.
•    Oesophageal candidiasis
•    Extrapulmonary or disseminated mycobacterial infection (acid-fast bacilli of undetermined species).
•    Kaposi's sarcoma
•    Lymphoid interstitial pneumonitis (LIP/PLH complex) in a child < 13 years of age.
•    HIV encephalopathy:

Clinical findings of disabling cognitive and/or motor dysfunction interfering with occupation or activities of daily living or loss of behavioural developmental milestones in child, progressing over weeks to months, in the absence of concurrent illness or condition other than HIV infection that could explain the findings. Methods to rule out such concurrent illnesses and conditions must include cerebrospinal fluid examination (and either brain imaging computed tomography or magnetic resonance) or autopsy.

** HIV wasting syndrome

Findings of profound involuntary weight loss (more than 10% of baseline body weight) plus other chronic diarrhoea (lasting > 1 month) or documented chronic fever and weakness (lasting > 1 month) in the absence of a concurrent illness or condition other than HIV infection that could explain the findings (e.g. cancer, tuberculosis, cryptosporidiosis or other specific enteritis).

III.    With evidence against HIV infection:

With laboratory test results negative for HIV infection, AIDS is ruled out for surveillance purposes unless the patient has had:

1.    Either of the following:

•    Pneumocystis carinii pneumonia diagnosed by a definitive method, or
•    a. any of the other diseases indicative of AIDS listed above in Section 1 diagnosed by a definitive method, and

b. a T-helper (T4) lymphocyte count < 400 per mm3.

2.    None of the other causes of immuno deficiency listed above in Section 1.

Reference. MMWR 1987; 36 (suppl no. 15): 35-155