Some standard content:
GB16000—1995
AIDS (Acquired Immunodeficiency Syndrome, referred to as AIDS) is a fatal sexually transmitted disease that has emerged in the past 10 years. Its pathogen is known to be caused by human immunodeficiency virus (Human Immunodeficiency Virus, referred to as HIV). Currently, there are two types of HIV-I and HIV-II. Both are transmitted through sexual contact, blood, blood products and syringes contaminated with HIV, and mother-to-child transmission. There is no specific treatment so far. After infection, the virus is carried for life, and the virus is easy to mutate. Anti-HIV antibodies in the blood indicate that HIV has been infected. Once AIDS develops, death is often caused by combined infections of various bacteria, viruses, fungi, protozoa and subtypes of tumors. The window period of HIV infection is generally 2 weeks to 3 months, and the incubation period of AIDS is 8 to 10 years. About 5% of patients have survived for 12 to 16 years. The length of the incubation period is negatively correlated with the infection dose. In the early stage, there are no clinical symptoms, but positive anti-HIV antibodies are found in the blood, which is called HIV infection. If symptoms and various complications appear, the patient has entered the AIDS stage. During the development of this standard, after referring to the standards revised by the Centers for Disease Control (CDC) in 1987 and 1993, we tried to combine the epidemiology, clinical practice and urban and rural conditions of our country to facilitate implementation and promotion. Appendix A and Appendix B of this standard are standard appendices; Appendix C, Appendix D, Appendix E and Appendix F of this standard are suggestive appendices. This standard is proposed by the Ministry of Health of the People's Republic of China. The drafting unit of this standard: Peking Union Medical College Hospital. The main drafter of this standard: Wang Aixia.
This standard is interpreted by the Ministry of Health's technical management unit, the Office of Supervision and Administration of Communicable Disease Prevention and Control of the Ministry of Health. 414
National Standard of the People's Republic of China
Diagnostic criteria and principles of management of HIV/AIDS
Diagnostic criteria and principles of management of HIV/AIDS1Scope
This standard specifies the diagnostic criteria and management principles of HIV/AIDS. GB16000-1995
This standard is applicable to all types of medical and health care institutions at all levels and can be used as a basis for medical staff to diagnose, report and treat HIV/AIIDS patients.
2 Referenced Standards
The provisions contained in the following standards constitute the provisions of this standard through reference in this standard. When this standard is published, the versions shown are valid. All standards will be revised, and parties using this standard should explore the possibility of using the latest version of the following standards. The diagnostic criteria for HIV/AIDS revised by the World Health Organization (WHO) and the Centers for Disease Control (CDC) in 1987, and the classification of HIV infection and the diagnostic criteria for AIDS revised by CDC in 1993 (see Appendix D, E, and F). 3 Diagnostic Criteria
3.1 Acute HIV Infection
3.1.1 Epidemiological History
3.1.1.1 Homosexual or heterosexual persons have a history of multiple sexual partners, or their spouse or sexual partner is positive for anti-HIV antibodies. 3.1.1.2 History of intravenous drug abuse
3 Use of imported blood products such as mute factors.
3. 1. 1. 3
3.1.1.4 History of close contact with HIV/AIDS patients. 3.1.1.5 History of sexually transmitted diseases such as syphilis, gonorrhea, non-gonococcal urethritis. History of going abroad.
3. 1. 1. 6
Children born to HIV(+) people.
3. 1. 1. 7
3.1.1.8 Blood transfusion that has not been tested for HIV. 3.1.2 Clinical manifestations
3.1.2.1 Symptoms of upper respiratory tract infection such as fever, fatigue, sore throat, and general discomfort. 3.1.2.2 Some have headaches, rashes, meningoencephalitis or acute polyneuritis. 3.1.2.3 There are enlarged lymph nodes in the neck, axilla and occipital region, similar to infectious mononucleosis. 3.1.2.4 Hepatomegaly and spleen enlargement.
3.1.3 Laboratory examination
3.1.3.1 The total number of WBC and lymphocytes in peripheral blood decreases after the onset of the disease, and the total number of lymphocytes increases later, and atypical lymphocytes can be seen. 3.1.3.2 The CD/CD ratio is greater than 1.
3.1.3.3 For those whose anti-HIV antibodies turn from negative to positive, it usually takes 2 to 3 months to turn positive. The longest time can be 6 months, and the antibodies are negative during the infection window period.
Approved by the State Administration of Technical Supervision on December 15, 1995 and implemented on July 1, 1996
GB 16000—1995
3.1.3.4 A small number of patients have positive serum P24 antigen in the early stage. 3.2 Asymptomatic HIV infection
3.2.1 Epidemiological history
Same as acute HIV infection.
3.2.,2 Clinical manifestations
Often without any symptoms or signs.
3.2.3 Laboratory examination
3.2.3.1 Anti-HIV antibody positive, confirmed by confirmatory test [see A2 in Appendix A (Standard Appendix)]. 3.2.3.2 CD, total lymphocyte count normal, CD./CD: greater than 1. 3.2.3.3 Serum P24 antigen negative.
3.3.1 Epidemiological history
Same as acute HIV infection.
3.3.2 Clinical manifestations
3.3.2.1 Unexplained immunodeficiency. 3.3.2.2 Continuous irregular low-grade fever for more than 1 month. 3.3.2.3 Persistent systemic lymphadenopathy of unknown cause (lymph node diameter greater than 1 cm). 3.3.2.4 Chronic diarrhea more than 4-5 times/day, weight loss greater than 10% within 3 months. 3.3.2.5 Combined with oral candidiasis, Pneumocystis carinii pneumonia, cytomegalovirus (CMV) infection, toxoplasmosis, cryptococcal meningitis, rapidly progressive active pulmonary tuberculosis, Kaposi sarcoma of the skin and mucous membranes, lymphoma, etc. 3.3.2.6 Dementia in young and middle-aged patients. 3.3.3 Laboratory examination
3.3.3.1 Anti-HIV antibody positive confirmed by confirmatory test. 3.3.3.2 P24 antigen positive (can be checked if conditions permit). 3.3.3.3 CD, total lymphocyte count less than 200/mm2 or 200~500/mm2. 3.3.3.4 CD/CD: less than 1.
3.3.3.5 Peripheral blood WBC, Hb decreased.
3.3.3.6 β2 microglobulin level increased. 3.3.3.7 The etiology or pathological basis of the above-mentioned various combined infections can be found. 3.4 Case classification
3.4.1 Confirmed cases
3.4.1.1 HIV-infected persons must have positive anti-HIV antibodies, and acute HIV infection is a high-risk group that has positive anti-HIV antibodies during the follow-up process. 3.4.1.2 AIDS cases: have any one of 3.3.1, 3.3.2 and 3.3.3.1, 3.3.3.3, 3.3.3.7 in 3.3.3.4 HIV/AIDS prevention principles
HIV has been isolated from the blood, semen, saliva, tears, cerebrospinal fluid, cervical secretions, and breast milk of HIV/AIDS patients. Blood and semen cause more opportunities for transmission. Generally, handshakes, social interactions and contact in daily life will not cause transmission. 4.1 Education and publicity: Through television, radio, brochures and health lectures, the general public should be made aware of the harmfulness and transmission routes of HIV/AIDS. 4.2 In addition to treating patients with STDs, STD clinics or prevention and treatment centers should try to test for anti-HIV antibodies, persuade their spouses or sexual partners to come to the hospital for examination and treatment, and educate them at the same time. 4.3 HIV/AIDS knowledge education should be provided to high-risk groups, such as prostitutes, homosexuals, and intravenous drug users. 4.4 HIV-infected and AIDS patients should have artificial abortions if they become pregnant. 4.5 Anti-HIV antibody testing should be carried out before blood donation for blood donors starting from large cities. Those who are positive are not allowed to donate blood. Epidemiological surveys should also be conducted. 416
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4.6 Medical units at all levels should strictly implement one needle and one syringe per person. If disposable syringes are not available, they should be strictly disinfected in accordance with the relevant provisions of the disinfection management regulations before use. Strengthen the disinfection of various medical instruments, especially oral instruments and endoscopes. 4.7 HIV/AIDS patients who have been detected and diagnosed should be educated and followed up regularly, and their family members should also be educated and guided. Those who have the conditions should be tested for anti-HIV antibodies, especially their spouses or sexual partners. 4.8 For intravenous drug users, not only education should be provided, but also their families should be mobilized to go to drug rehabilitation centers for drug rehabilitation. Due to the high relapse rate, drug users and their families should be informed of the serious consequences and transmission routes of HIV/AIDS. 4.9 Medical units at all levels shall draw blood from suspected HIV/AIDS patients and send them to epidemic prevention stations for testing of anti-HIV antibodies. Confirmed HIV/AIDS patients shall be reported to the Ministry of Health in accordance with the Law of the People's Republic of China on the Prevention and Control of Infectious Diseases and the Measures for the Implementation of the Law of the People's Republic of China on the Prevention and Control of Infectious Diseases.
5 Treatment principles of HIV/AIDS
No special medication is required for acute HIV infection and HIV infection without clinical symptoms. You only need to pay attention to rest, strengthen nutrition and combine work and rest, but be careful to avoid infecting others. The treatment of AIDS patients is mainly aimed at etiology and various complications, and also includes support, immunomodulation and psychological treatment. If P24 antigen is positive, CD, total lymphocyte count is less than 200/mm2, drugs such as AZT (Azidothimidine, azidothymidine) that inhibit HIV reverse transcriptase can be used to reduce the replication of HIV virus. 5.1 Rest
HIV patients can work and study as usual, but AIDS patients need to pay attention to rest when they have symptoms such as low fever, diarrhea, or have various infections.
5.2 Strengthen nutrition
AIDS patients often suffer from malnutrition due to fever, oral candidiasis or herpes virus infection, which makes them unable to eat well. They already have low immune function. In addition, malnutrition is more likely to cause complications such as tuberculosis. Therefore, a high-protein diet is recommended. 5.3 Etiological treatment
At present, the most commonly used drugs are AZT (azidothymidine), DDI (dideoxyinosine) and DDC (dideoxycytidine), which inhibit reverse transcriptase and block HIV replication in cells and can be used in combination. 5.4 Immunomodulatory drugs
5.4.1 Interferon
It has antiviral and immunomodulatory effects. The dose is 3 Miu intramuscular injection three times a week for 3 to 6 months per course of treatment. 5.4.2 Interleukin-I (IL~I)
IL-Ⅱ can increase the number of lymphocytes in patients and improve immune function. At present, recombinant IL-Ⅱ is mostly used (5.4.15.4.2 have side effects such as fever).
5.4.3 Immunoglobulin
As the humoral immune function of AIDS patients is also affected, they are prone to various bacterial infections. Regular use of immunoglobulin can reduce the occurrence of bacterial infections.
5.4.4 Chinese medicine
Such as Lentinan, Salvia miltiorrhiza, Astragalus and glycyrrhizin also have the effect of adjusting immune function. At present, some research work has found that some Chinese medicines or their components can inhibit HIV in in vitro experiments, which has good prospects. 5.5 Treatment of various complications
5.5.1 Oral Candida infection
AIDS patients often have repeated oral Candida infection, which sometimes extends to the tonsils and posterior pharyngeal wall. They can apply nystatin and glycerin locally, or mix it into a viscous paste and swallow it slowly, or take itraconazole or fluconazole orally. 5.5.2 Pneumonia of Carinii
Clinical manifestations: dyspnea, obvious po, low (about 70 mmHg), but the chest card shows that the lesion is not too serious, combined with the medical history and anti-HIV (+), this disease can be considered. TMPco can be taken orally. After recovery, it is necessary to take it intermittently to prevent recurrence. When taking it for a long time, pay attention to blood, urine and kidney 417
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function. Pentamidine is taken orally or inhaled by aerosol abroad. 5.5.3 Bacterial infection
There are recurrent salmonella infections, such as blood culture (ten) can be taken orally with quinolones. The United States recently reported that the incidence of tuberculosis and atypical mycobacterial infection in AIDS patients is high and progresses rapidly. Triple or quadruple anti-tuberculosis drugs can be used, and liver and kidney function should also be paid attention to during medication.
5.5.4 Cryptococcal meningitis
The treatment focuses on reducing intracranial pressure. 20% mannitol can be used, or ventricular drainage can be performed. For antibiotics, amphotericin B or fluconazole can be used. After the condition stabilizes, fluconazole can be taken orally.
5.5.5 Herpes virus infection
Acyclovir can be taken orally for skin herpes zoster, and acyclovir or interferon can be taken orally for mucosal herpes simplex or cytomegalovirus infection. 5.5.6 Cryptosporidiosis
SD and pyrimethamine can be taken orally. Spiramycin can also be taken orally, but the effect is not certain. 5.5.7 Cryptosporidiosis
The main symptom is diarrhea. There is no specific treatment at present. Isospora and Microsporidia can also cause diarrhea and small intestinal malabsorption. Sometimes special staining and electrostaining of stool smears are required for diagnosis. Treatment is fluid replacement and electrolytes and adjustment of immune function. 5.5.8 Tumors
Fast-growing Kaposi sarcoma can be treated with vincristine (or vinblastine), bleomycin or doxorubicin, or interferon for half a year to one year, with good results. Local radiotherapy can also be used. 118
A1 Preliminary screening method
GB16000-1995
Appendix A
(Standard Appendix)
Principle and method of anti-HIV antibody detection
A1.1 Particle Agglutination Test Test steps:
a) Pipette 75ul serum diluent into the first well, and add 25μL serum diluent to the second and third wells respectively. b) Add 25 μl of serum sample. Use a micropipette to repeatedly pipette 3-4 times in the first well to mix the liquid inside, then pipette 25 μL of the liquid in the first well to the second well and mix it, then pipette 25 μL of liquid from the second well to the third well and mix it, and finally pipette 25 μL of liquid from the third well and discard it. c) Use a pipette to add a drop (25 μl) of non-sensitized particles to the second well and a drop of sensitized particles to the third well. d) Use a horizontal oscillator to oscillate for 30-60 seconds, then cover the lid and place it flat at room temperature of 15-25℃ for 2 hours to see the results. c) Result explanation:
After the test is completed, adding non-sensitized particles (the final serum dilution is 1:16) should show a negative reaction, while adding sensitized particles (the final serum dilution is 1:32) should show agglutination reaction, which is positive. The first well is a blank control. Each test needs to have a positive control and a negative control. If the result is not certain, repeat the test with other methods. A1.2 ELISA Enzyme-linked Immunosorbent Assay A1.2.1 Indirect ELISA
Result explanation: Those with anti-HIV antibodies are positive, and those without are negative. A1.2.2． Competitive EIA
Patient serum
With anti-HIV antibodies
Enzyme-labeled anti-human globulin
Patient serum anti-HIV antibodies
HIV antigen
Anti-HIV antibodies
HIV antigen
Result explanation: Patient serum with anti-HIV antibodies is colorless or very light, while those without anti-HIV antibodies show a clear color.
A1.2.3 Antigen sandwich method (or antibody capture method) Antigen + patient serum (with or without anti-HIV antibodies) + enzyme-labeled antigen. This method is more sensitive and specific because it can detect LgA, LgM, and LgG anti-HIV antibodies in patient serum. Result explanation: Color is positive for anti-HIV antibodies, and colorless is negative. 419
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Test steps [a and c)] As indirect method used by Bio-Rad reagent: a) Add 200μL diluent to the wells coated with antigen. b) Add 10 μL of patient serum and positive and negative control solutions to the wells of diluent. c) Cover and incubate at 37℃±2℃ for 30min, and prepare enzyme label at the same time. d) Wash each well 6 times with cleaning solution, 300μL per well, and absorb the water in each well. e) Add 100μL enzyme label, incubate at 37℃±2C for 15min, and prepare substrate at the same time. f) Wash 6 times with cleaning solution, and absorb each well. g) Add 100μL of substrate (OPD, o-phenylenediamine) to each well and incubate at 37℃±2℃ for 15min. h) Add 100μL of stop solution to each well and tap the microplate. i) Read the OD value at 492nm wavelength (the OD value must be read within 1h after adding the stop solution). j) Each experiment must have more than 2 positive and 2 negative control values. Calculate the Cutoff value = (0.1×average OD value of positive control) minus the average OD value of negative control. Result explanation: OD value>Cutoff value is positive. Once there is a positive result, it needs to be repeated once. If it is still positive, it needs to be confirmed by protein blotting or immunofluorescence. Some test kits have both HIV-1 and HIV-2, while others can only detect HIV-1. HIV-1 is more common in China, the United States and Western Europe, and HIV-2 is found in West Africa. This method can detect IgM antibodies in serum, which is helpful for those who are infected in the early stage. A1.3 Immunofluorescence detection
Antigen negative film: Cells are fixed in each well of the glass slide, and HIV antigens are present in the cells. Detection steps:
a) Dilute the serum to be tested at 1:10 and add it to the well of HIV antigen. Set up a positive control and a negative control for each glass slide, and incubate at 37°C for 45 minutes.
b) Wash three times with 10mol/L pH7.2-7.6 PBS solution, wash once with distilled water, and dry. c) Add 1:16 diluted anti-human IgG fluorescent labeled antibody to each well, and incubate at 37°C for 45 minutes. d) Wash three times with PBS and dry.
e) Stain with 0.1% Evans blue for 15 minutes, take out and dry slightly. f) Add 50% glycerol to seal the slide and detect under a fluorescence microscope. Result explanation: Those with emerald green fluorescence in the cytoplasm and cell membrane are positive, and dark red is negative. A2 Confirmatory test
Confirmatory test must be performed after the above-mentioned initial screening test is positive. A2.1 Western Blot (Abbott) A2.1.1 Test steps
a) Add 1.5mL of diluent to each reaction tank. Generally, there are 9 reaction tanks on a reaction plate. Then add 3μL of the serum sample to be tested to each reaction tank.
b) Add a numbered nitrocellulose membrane strip to each tank and shake it gently on a shaker at room temperature for 2 hours. c) Aspirate the reaction solution and wash it 4 times with cleaning solution, using 2mL for each tank each time. Shake for 2 to 3 minutes each time, and then aspirate the cleaning solution. d) Add 1.5mL of enzyme-labeled antibody to each reaction tank and shake it at room temperature for 1 hour. e) Repeat step c) for 4 times, and finally wash each tank once more with 1.5mL of substrate buffer. f) Add 1.5 mL of the newly prepared substrate solution to the reaction tank and continue shaking for 3 to 5 minutes. After the positive control shows a zone, quickly remove the liquid in each tank and add 1.5 mL of stabilizing solution and continue shaking for 20 to 30 minutes. g) Take out the nitrocellulose membrane strips in each reaction tank, dry them in the dark, and judge the results. A2.1.2 Result interpretation
According to the provisions of the Ministry of Health's document No. 1990 (2), the judgment standard of the protein blotting method is: 420
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a) Nature: at least one env (gp160, gp120, gp41) band and one pol (p65, p51, p32) band or at least one env band and one gag (p55, p24, p18) band or at least one env band and one gag band, one pol band or at least 2 env bands.
b) Negative: no virus-specific band.
c) \Suspicious: one gag band and one pol band or only gag band or
only pol band.
Appendix B
(Standard Appendix)
Pathogenic detection of AIDS combined with various infections B1 Examination of Pneumocystis carinii
Pneumocystis carinii often causes pneumonia. A large number of parasites exist in the lower respiratory tract and lung tissue of patients. Specimens obtained by collecting sputum or suctioning bronchial secretions, bronchial lavage fluid or lung biopsy can be made into smears and printed into tissue sections. Use Giemsa or hematoxylin-eosin staining to observe Pneumocystis carinii cysts or trophozoites. The nucleus of the parasite is red, the cytoplasm is blue-gray, and the cyst contains 8 parasites arranged in a clock-shaped shape. If the outer membrane of the cyst is haloed black with silver staining, the trophozoite does not show color. B2 Cryptosporidium Examination
Cryptosporidium is an important pathogen of diarrhea in AIDS patients. B2.1 Take the patient's stool specimen to make a smear. For formed stool, you can use physiological saline to mix the smear and wait for natural drying or alcohol drying. B2.2 First stain with carbolic acid fuchsin, wash with water after 2 minutes, and then decolorize with 10% sulfuric acid aqueous solution. B2.3 Stain with 0.2% malachite green solution for 1 minute, then wash with water, dry, and examine with a microscope oil lens. The stained Cryptosporidium eggs are rose red, the background is blue-green, the eggs are round or cystic, 3 to 5μm in size, with strip-shaped sporozoites and line deposits. For Cryptosporidium cysts with very few numbers, the specimen can be centrifuged with formaldehyde-ether or sucrose flotation egg collection method. Smearing and then staining can increase the detection rate. B3 Toxoplasma antibody detection
B3.1 Detect toxoplasma antibodies in serum by immunofluorescence or EIA. B3.2 If there is a tissue biopsy, it can be sliced and stained with HE. Sometimes typical Toxoplasma protozoa can be seen. B4 Various fungal examinations
B4.1 Smear: Take a smear of the white film of oral candidiasis infection, and special fungal spores and hyphae can be seen. B4.2 Cerebrospinal fluid, etc. can be centrifuged, and the sediment can be smeared and stained with India ink. Typical cryptococci can be found, with a layer of membrane on the outside. The most specific is that budding can be seen. Blood or cerebrospinal fluid can also be taken, and cryptococcal antibodies can be detected under a microscope using the ELISA method. B5 Various herpes virus examinations
B5.1 Take scrapings of oral and respiratory secretions and herpes fluid smears and stain them with Giemsa or HE to observe cell lesions and inclusion bodies. B5.2 Use EIA to check the antibodies of CMV, EBV, HSV-1, and HSV-2 in the patient's blood. B6 Detection of HBVM and anti-HCV or HCV RNA
B6.1 EIA can be used to detect HBsAgantiHBs, HBeAg, antiHBe, antiHBc and anti-HCV antibodies. 121
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B6.2 Currently, PCR can also be used to detect HCV RNA. B7 Bacterial detection
B7.1 The pathogens of various complications can be diagnosed by bacterial culture of blood, sputum, cerebrospinal fluid, etc. B7.2 Tuberculosis and atypical mycobacterial infection are common in AIDS patients. If necessary, in addition to checking sputum for acid-fast bacilli, lymph node puncture, bone marrow puncture, lung or liver tissue puncture for bacterial culture and pathology can be performed to further diagnose occult mycobacterial infection. Appendix C
(Suggested Appendix)
Dosages of various drugsWww.bzxZ.net
C1 AZT (Azidothimidine, AZT, trade name Zidovudine) 100~200 mg 3/day. C2 DDC (Dideoxycytidine) 0.75 mg 3/day. C3 DDI (Dideoxyinosine) 250 mg 2/day. The above 3 are oral drugs. Attention should be paid to the side effects of gastrointestinal reactions and decreased blood WBC. Two drugs can be combined or used alternately.
C4 α-interferon 3 million Iu subcutaneous or intramuscular injection, three times a week, 3 to 6 months/course of treatment. C5 Interleukin-I (IL-) 2.5 million Iu, continuous intravenous drip for 24 hours, 5 days a week, a total of 4 to 8 weeks. C6 Nystatin tablets 500,000 IU, 1 million IU can be crushed and mixed with glycerin to make a paste for topical application. C7 Itraconazole 200 mg/day × 7 days, oral. C8 Fluconazole 50-200 mg/day × 14 days, oral or intravenous drip 200-400 mg/day. C9 Trimethoprim-sulfamethoxazole (TMPco) #2-4/times, 4-5 times/day. C10 Pentamidine 4 mg/kg/day), dissolved in 150-200 mL 5% glucose solution and slowly dripped intravenously, the course of treatment is 3 weeks; or pentane 600 mg dissolved in 6 mL injection water for nebulization inhalation, once/day; if treating Pneumocystis carinii pneumonia, continue for 3 weeks.
Sulfadizine (SD) 100-200 mg/(kg·day), divided into 4 times/day, such as for the treatment of toxoplasmosis, the course of treatment is 2-3 weeks.
C12 Pyrimethamine 75 mg for the first dose, followed by 25 mg/day, such as for the treatment of toxoplasmosis, the course of treatment is 2-3 weeks. C13 Spiramycin 0.3-0.4 g, 3 times/day, such as for the treatment of cryptosporidium enteritis, the course of treatment is 3-6 weeks. Appendix D
(Reminder Appendix)
About the classification of HIV/AIDS in adolescents and adults and the expanded AIDS diagnostic criteria revised by the Centers for Disease Control (CDC) in 1993 The classification of HIV infection and the diagnostic criteria for AIDS in adolescents (age ≥13 years) and adults revised by the Centers for Disease Control (CDC) in 1993 adopted a classification method combining clinical typing with CD4+ T cell counts [see Morbidity and Mortality Weekly Report (MMWR), 1992, 41/RR-17]. Its main contents are: D1 According to the clinical characteristics of HIV-infected patients, they are divided into three types: A, B, and C. D1.1 Clinical type A
is seen in one of the following three clinical characteristics: a) acute (primary) HIV infection with symptoms similar to influenza or infectious mononucleosis; b) asymptomatic HIV infection;
c) persistent generalized lymphadenopathy (PGL). D1.2 Clinical type B
GB 16000—1995
Suffering from the following non-specific symptoms (or signs), mainly including: a) bacillary angioma;
: b) portal candidiasis;
c) chronic, recurrent or poorly responsive vulvovaginal candidiasis; d) cervical (moderate or severe) atypical hyperplasia or carcinoma in situ; e) systemic symptoms lasting for more than one month such as fever (38.5℃C) or diarrhea; f) oral hairy leukoplakia;
g) multiple or recurrent skin herpes zoster; h) idiopathic thrombocytopenic purpura;
i) listeriosis;
j) pelvic inflammatory disease mainly complicated by fallopian tube and ovarian abscess; k) peripheral neuropathy.
Any of the above symptoms may be related to the cellular immune deficiency after HIV infection, but they do not meet the diagnostic criteria for the AIDS stage and are different from the clinical characteristics of type A. Some of these symptoms were previously called AIDS-related complex (ARC). D1.3 Clinical type C
Is the AIDS stage. It includes 25 diseases with AIDS indications. Anyone who suffers from any of them and is HIV antibody positive can be diagnosed with AIDS. They are:
a) tracheal, bronchial or pulmonary candidiasis; b) esophageal candidiasis;
c) invasive cervical cancer;
d) diffuse or extrapulmonary coccidioidomycosis; e) extrapulmonary cryptococcosis;
f) chronic intestinal cryptosporidiosis (duration more than 1 month); g) cytomegalovirus infection other than liver, spleen and lymph nodes; h) cytomegalovirus retinitis complicated by blindness; i) HIV-related encephalopathy;
j) chronic oral ulcers (duration more than 1 month) or bronchitis, pneumonia and esophagitis caused by herpes simplex virus infection; k) diffuse or extrapulmonary histoplasmosis; 1) chronic Enteric spore coccidiosis (duration greater than 1 month); m) Kaposi's sarcoma;
n) Burkitt's lymphoma;
0) Immunoblastic lymphoma;
p) Primary brain lymphoma;
q) Diffuse or extrapulmonary Mycobacterium avium disease; r) Pulmonary or extrapulmonary tuberculosis;
s) Diffuse or extrapulmonary other mycobacterial infections; t) Pneumoniae carinii pneumonia;
u) Recurrent pneumonia;
v) Progressive polyleukoencephalopathy;
w) Recurrent Salmonella septicemia; x) Equinoplastis cerebral plasmodium;
y) HIV-associated wasting syndrome.
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D2 According to the results of CD,+T cell count, each clinical type is divided into three subtypes (see Table D1). It is also stipulated that all HIV-infected persons with CD,+T cells less than 200/uL or less than 14% of the total lymphocyte count should also be treated according to the AIDS case report form D1 CDC 1993 revised adult HIV infection classification and expanded AIDS diagnostic criteria clinical classification
HIV infection classification
CD,+T cell count
≥500/μL
200~499/μL
<200/μL (with
AIDS-indicating T cell count
Asymptomatic, acute HIV
infection or PGL!
1) Refers to persistent systemic lymphadenopathy.
Symptomatic, but not
same as A or C
AIDS-indicating diseases
The outstanding feature of the new CDC classification system is that it emphasizes the clinical importance of detecting CD,+T cell counts: a) It expands the diagnostic criteria for AIDS cases to include clinical type C (25 AIDS-indicating diseases) and AIDS-indicating CD,T cell counts;
b) It helps guide clinical antiretroviral and infection prevention treatment. It is currently advocated that if the CD,+T cell count of HIV-infected patients is less than 500/μuL, there is an indication for the use of antiretroviral drugs (such as AZT, DDC, etc.); if the CD,+T cell count is less than 200/μL, drugs to prevent Pneumocystis carinii pneumonia should be used. However, recent literature reports: ① In rare cases, HTLV-I and HIV co-infection can occur simultaneously. Although it usually causes HIV disease progression, the number of CD4+T cells is significantly higher than that of HIV-infected patients alone; ② In some (5% to 15%) AIDS patients with Pneumocystis carinii pneumonia, the number of CD4+T cells is greater than 200/μL. Therefore, in these cases, the timing of antiviral and opportunistic infection prevention medication may be affected based solely on the number of CD4+T cells. This suggests that in actual work, it should be closely combined with the specific clinical situation. Table D2
Diagnostic criteria for HIV/AIDS in children
Clinical stages
Asymptomatic
HIV infection
HIV/AIDS
Vertical exposure
Anti-HIV antibodies (+)
or (—)
Early onset
(—)～Late onset+
Appendix E
(Suggestive appendix)
Age of children
<18 months
>18 months||tt ||>18 months
>18 months
Antibodies may come from HIV-infected mothers
After antibodies appear, P24 turns negative
Children develop various opportunistic infections
Or have slow reactions and intellectual disability
HIV reproduction increases, and P24 turns from negative to positive
Mother is HIV/AIDS
The diagnostic criteria for HIV/AIDS established by the World Health Organization and the U.S. Centers for Disease Control (CDC) in 1987 (Weekly Epidemiological Record, 1988,63: 1-8) E1 AIDS case definition for surveillance purposes revised by the World Health Organization and the US Centers for Disease Control in 1987 424
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Reporting of AIDS cases to the country is determined based on whether the patient has the characteristics of one or more of the following indicative diseases (referring to opportunistic infections and malignant tumors) and laboratory evidence of HIV infection. E1.1 Diagnosis of AIDS in the absence of laboratory evidence of HIV infection If no laboratory test for HIV is performed or there is no confirmed laboratory result, and the patient has ruled out the causes of immunodeficiency listed in E1.1.1, as long as any of the diseases listed in E1.1.2 is met, AIDS can be diagnosed. E1.1.1 In the absence of laboratory evidence of HIV infection, if any of the following causes of immunodeficiency are present, AIDS cannot be diagnosed. a) Treatment with high-dose or long-term systemic corticosteroids or other immunosuppressants or cytotoxic drugs within 3 months before the onset of the indicative disease.
b) Any of the following diseases within 3 months of diagnosis of the indicative disease: Hodgkin's disease, non-Hodgkin's lymphoma (excluding primary brain lymphoma), lymphocytic leukemia, multiple myeloma, any lymphoreticular endothelial cell or histiocytic tumor, angioimmunoblastic lymphadenopathy.
c) Hereditary (congenital) immunodeficiency syndrome or acquired immunodeficiency syndrome with atypical HIV infection, such as hypogammaglobulinemia.
E1.1.2 If the indicative disease is confirmed by E3, AIDS can be diagnosed. a) Candidiasis of the esophagus, trachea, bronchus and lungs; b) Cryptococcosis outside the lungs;
c) Cryptosporidiosis with persistent diarrhea for more than one month; d) Cytomegalovirus infection of organs other than the liver, spleen or lymph nodes in patients over one month old; e) Mucosal ulcers caused by herpes simplex virus infection lasting for more than one month; or bronchitis, pneumonia or esophagitis of any duration in patients over one month old;
f) Kaposi's sarcoma patients under sixty years old; g) Patients aged six or seven years old or older h) Children under 13 years old with lymphointerstitial pneumonia and/or pulmonary lymphoproliferation (LIP/PLH complex); i) Disseminated Mycobacterium islandii complex or Mycobacterium kansasii disease (any site or simultaneous infection of sites other than the lungs, skin, cervix or hilar lymph nodes); ji) Pneumocystis carinii pneumonia; k) Progressive multifocal leukoencephalopathy; 1) - Patients with brain toxoplasmosis over the age of 1 month. E1.2 Laboratory evidence of HIV infection
Regardless of the presence of other causes of immunodeficiency listed in F1.1.1, as long as there is laboratory evidence of HIV infection in E2 and E1.1.Any of the following 2 diseases can be used to diagnose AIDS. E1.2.1 The diagnosis of AIDS can be made for the indicative diseases confirmed according to E3. a) Children aged 13 years and below who have two or more of the following bacterial infections (multiple or recurrent) within two years: sepsis, pneumonia, meningitis, bone or joint infections, or organ or body cavity abscesses (excluding otitis media, epidermal or mucosal abscesses) caused by Haemophilus, Streptococcus (including Streptococcus pneumoniae) or other purulent bacteria; b) disseminated coccidioidomycosis (infection of one site other than the lungs, skin, cervix or hilar lymph nodes, or simultaneous infection of these sites); c) HIV encephalopathy (also known as "HIV dementia", "AIDS dementia", or "HIV dementia caused by HIV" IV) (see E3); d) disseminated histoplasmosis (infection of one site other than the lung, skin, cervix, or hilar lymph nodes, or a combination of these sites); e) persistent diarrhea for more than 1 month with isosporiasis; f) Kaposi's sarcoma of any age;
g) primary brain lymphoma of any age; h) other: B-cell or non-Hodgkin's lymphoma of unknown immunological phenotype and the following histologic types: (i) small non-mitotic foveal lymphoma (whether Burkitt's or non-Burkitt's); 123
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