Appendix: Revised Surveillance Case Definition for HIV Infection*
This revised definition of HIV infection, which applies to any HIV (e.g., HIV-1 or
HIV-2), is intended for public health surveillance only. It incorporates the reporting
criteria for HIV infection and AIDS into a single case definition. The revised criteria
for HIV infection update the definition of HIV infection implemented in 1993 (18); the
revised HIV criteria apply to AIDS-defining conditions for adults (18) and children
(17,19), which require laboratory evidence of HIV. This definition is not presented as a
guide to clinical diagnosis or for other uses (17,18).
In adults, adolescents, or children aged greater than or equal to 18 months**, a
reportable case of HIV infection must meet at least one of the following criteria:
Laboratory
Criteria
Positive result on a screening test for HIV antibody (e.g., repeatedly reactive enzyme
immunoassay), followed by a positive result on a confirmatory (sensitive and more
specific) test for HIV antibody (e.g., Western blot or immunofluorescence antibody test)
or
Positive result or report of a detectable quantity on any of the following HIV virologic
(nonantibody) tests:
HIV nucleic acid (DNA or RNA) detection (e.g., DNA polymerase chain reaction [PCR] or
plasma HIV-1 RNA)***
HIV p24 antigen test, including neutralization assay
HIV isolation (viral culture)
OR
Clinical or Other Criteria (if the above laboratory criteria are not met)
Diagnosis of HIV infection, based on the laboratory criteria above, that is documented
in a medical record by a physician
or
Conditions that meet criteria included in the case definition for AIDS (17-19)
In a child aged less than 18 months, a reportable case of HIV infection must
meet at least one of the following criteria:
Laboratory Criteria
Definitive
Positive results on two separate specimens (excluding cord blood) using one or more of
the following HIV virologic (nonantibody) tests:
HIV nucleic acid (DNA or RNA) detection
HIV p24 antigen test, including neutralization assay, in a child
greater than or equal to 1
month of age
HIV isolation (viral culture)
or
Presumptive
A child who does not meet the criteria for definitive HIV infection but who has:
Positive results on only one specimen (excluding cord blood) using the above HIV
virologic tests and no subsequent negative HIV virologic or negative HIV antibody tests
OR
Clinical or Other Criteria (if the above definitive or presumptive laboratory criteria
are not met)
Diagnosis of HIV infection, based on the laboratory criteria above, that is documented
in a medical record by a physician
or
Conditions that meet criteria included in the 1987 pediatric surveillance case
definition for AIDS (17,19)
A child aged less than 18 months born to an HIV-infected mother will be
categorized for surveillance purposes as "not infected with HIV" if the child
does not meet the criteria for HIV infection but meets the following criteria:
Laboratory
Criteria
Definitive
At least two negative HIV antibody tests from separate specimens obtained at greater
than or equal to 6 months of age
or
At least two negative HIV virologic tests* from separate specimens, both of which were
performed at greater than or equal to 1 month of age and one of which was performed at
greater than or equal to 4 months of age
AND
No other laboratory or clinical evidence of HIV infection (i.e., has not had any
positive virologic tests, if performed, and has not had an AIDS-defining condition)
or
Presumptive
A child who does not meet the above criteria for definitive "not
infected" status but who has:
One negative EIA HIV antibody test performed at greater than or equal to 6 months of age
and NO positive HIV virologic tests, if performed
or
One negative HIV virologic test* performed at greater than or equal to 4 months of age
and NO positive HIV virologic tests, if performed
or
One positive HIV virologic test with at least two subsequent negative virologic
tests****, at least one of which is at greater than or equal to 4 months of age; or
negative HIV antibody test results, at least one of which is at greater than or equal to 6
months of age
AND
No other laboratory or clinical evidence of HIV infection (i.e., has not had any
positive virologic tests, if performed, and has not had an AIDS-defining condition).
OR
Clinical or Other Criteria (if the above definitive or presumptive laboratory criteria
are not met)
Determined by a physician to be "not infected", and a physician has noted the
results of the preceding HIV diagnostic tests in the medical record
AND
NO other laboratory or clinical evidence of HIV infection (i.e., has not had any
positive virologic tests, if performed, and has not had an AIDS-defining condition)
A child aged less than 18 months born to an HIV-infected mother will be
categorized as having perinatal exposure to HIV infection if the child does not meet the
criteria for HIV infection (II) or the criteria for "not infected with HIV"
(III).
* Draft revised surveillance criteria for HIV infection were approved and recommended
by the membership of the Council of State and Territorial Epidemiologists (CSTE) at the
1998 annual meeting (11). Draft versions of these criteria were previously reviewed by
state HIV/AIDS surveillance staffs, CDC, CSTE, and laboratory experts. In addition, the
pediatric criteria were reviewed by an expert panel of consultants. [External Pediatric
Consultants: C. Hanson, M. Kaiser, S. Paul, G. Scott, and P. Thomas. CDC staff: J.
Bertolli, K. Dominguez, M. Kalish, M.L. Lindegren, M. Rogers, C. Schable, R.J. Simonds,
and J. Ward]
** Children aged greater than or equal to 18 months but less than 13 years are
categorized as "not infected with HIV" if they meet the criteria in III.
*** In adults, adolescents, and children infected by other than perinatal exposure,
plasma viral RNA nucleic acid tests should NOT be used in lieu of licensed HIV
screening tests (e.g., repeatedly reactive enzyme immunoassay). In addition, a negative
(i.e., undetectable) plasma HIV-1 RNA test result does not rule out the diagnosis of HIV
infection.
**** HIV nucleic acid (DNA or RNA) detection tests are the virologic methods of choice
to exclude infection in children aged less than 18 months. Although HIV culture can be
used for this purpose, it is more complex and expensive to perform and is less well
standardized than nucleic acid detection tests. The use of p24 antigen testing to exclude
infection in children aged less than 18 months is not recommended because of its lack of
sensitivity.
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