WHO has developed a clinical staging system for HIV infection and HIV-related disease (see Chapter l).The main uses are for prognosis and for deciding when to start antiretroviral therapy.The features of paediatric HIV/AIDS are not very specific in developing countries where childhood malnutrition is common and TB is endemic. Severe malnutrition or wasting in a school-aged child or in a child from a well-nourished family is unlikely to be due simply to poor intake. This should raise the suspicion of underlying disease, e.g. HIV or TB or both.The table below lists clinical signs suggestive of HIV infection. Many are more specific than those in the WHO clinical staging system but are less sensitive. In other words, the presence of a particular sign strongly suggests HIV infection, but many children have HIV infection without that sign. The interpretation of clinical signs also depends on local patterns of disease. For example, splenomegaly is commonly caused by malaria in sub-Saharan Africa, where its specificity as a sign of HIV-related disease is therefore low.
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