The natural history of HIV-1 infection: staging classifications of disease.
We evaluated and compared four staging classification systems for HIV infection in a population-based cohort: (1) a staging based on prodromal clinical criteria; (2) the Walter Reed Staging Classification (WRSC); (3) the immunologic staging system (ISS), and (4) a simple staging based on oral disease and CD4+ T-cell depletion. The staging systems were applied to 386 HIV-infected men in the San Francisco Men's Health Study cohort who did not have AIDS at the baseline examination. After 48-56 months of follow-up the cumulative incidence of AIDS and the cumulative mortality by stage was determined for each staging. Unlike the other systems, the WRSC could not classify a substantial proportion of HIV-infected men (51.9%). The WRSC and ISS include one or more stages which did not appear to be associated with a prognosis substantially different from that of adjacent stages. The simplified staging system based on CD4+ T-cell depletion and oral disease may be the most effective of the systems studied. A more complete understanding of the pathophysiology during the evolution of HIV infection will be required to define a more detailed staging of this disease.
Royce
R A
RA
Department of Biomedical and Environmental Health Sciences, School of Public Health, University of California, Berkeley.
Luckmann
R S
RS
Fusaro
R E
RE
Winkelstein
W
W
D000163:Acquired Immunodeficiency Syndrome / Q000276:immunology / Q000401:mortality; D000328:Adult; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology; D015331:Cohort Studies; D005500:Follow-Up Studies; D015658:HIV Infections / Q000145:classification* / Q000276:immunology / Q000401:mortality; D006679:HIV Seropositivity / Q000145:classification / Q000401:mortality; D015528:HIV Seroprevalence; D015497:HIV-1; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012495:San Francisco / Q000453:epidemiology; D050378:T-Lymphocytes, Regulatory / Q000276:immunology