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There is no standard definition of primary HIV infection. However, reporting primary HIV infection, where recognized and documented, is useful and should be encouraged. The United States Centers for Disease Control and Prevention (CDC) are expected to develop a case definition for reporting primary HIV infection. Primary HIV infection can be recognized in infants, children, adolescents and adults; it can be asymptomatic or be associated with features of an acute retroviral syndrome of variable severity. Primary infection usually presents as an acute febrile illness 2–4 weeks postexposure, often with lymphadenopathy, pharyngitis, maculopapular rash, orogenital ulcers and meningoencephalitis. Profound transient lymphopaenia (including low CD4) can develop, and opportunistic infections may occur, but these infections should not be confused with clinical staging events developing in established HIV infection. Primary HIV infection can be identified by recent appearance of HIV antibody or by identifying viral products (HIV-RNA or HIV-DNA and/or ultrasensitive HIV p24 antigen) with negative (or weakly reactive) HIV antibody.
Initially in 1990, a four-stage clinical staging system was developed for clinical purposes and only for adults. Subsequently in 2002, a three-stage system for children was proposed to support rolling out ART. This publication revises the 2003 WHO clinical staging of HIVrelated disease in infants and children, which is now harmonized with the 1990 classification of disease for adults and adolescents. This is similar to the four-stage clinical classification of the United States CDC revised in 1994 and originally intended for surveillance purposes [26]. Both the United States CDC and WHO clinical classifications recognize primary HIV infection. It is also proposed that the appearance of newor recurrent clinical staging events or immunodeficiency be used to assess individuals once they are receiving ART. Clinical assessment prior to treatment Clinical staging is used once HIV infection has been confirmed (serological and/or virological evidence of HIV infection). An additional presumptive clinical diagnosis of severe HIV disease (equivalent to severe immunodeficiency) among infants younger than 18 months is suggested for use in situations in which definitive virological diagnosis of HIV infection is not readily available .
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