Revised pediatric HIV classification system

Resident: J. Hencler
Date: 02/26/2010

Article title: Revised pediatric HIV classification system
Author(s): AAPD
Journal: Pediatric Dentistry-18:2,1996

Major topic: HIV
Type of Article: Revision

Key points in the article discussion:
In 1994, a new classification system for pediatric HIV replaced the 1987 system (see tables)

Category N (not symptomatic): Includes children who have no signs or symptoms considered to be the result of HIV infection or who have only one of the conditions listed in Category A.

Category A (mildly symptomatic): Children with two or more of the conditions listed below but none of the conditions listed in Categories B and C. (see list)

Category B (moderately symptomatic): Children who have symptomatic conditions other than those listed for Category A or C that are attributed to HIV infection. Examples of conditions in clinical Category B include but are not limited to: (see list)

Category C (severely symptomatic): Serious bacterial infections, multiple or recurrent (i.e., any combination of at least two culture-confirmed infections within a 2-year period), of the following types: septicemia, pneumonia, meningitis, bone or joint infection, or abscess of an internal organ or body cavity (excluding otitis media, superficial skin or mucosal abscesses, and indwelling catheter-related infections). (see list)

Summary of conclusions: New pediatric HIV classification system is simpler. It would be good to have a reference manual if needed.

Assessment of article: This revision of the pediatric HIV classification system is good to be aware of because many signs and symptoms of HIV infection can manifest in the oral cavity. This classification is also pertinent to us as pediatric dentists when consulting with a Pediatrician about a child’s HIV status and severity.

Oral manifestations of HIV in kids

Resident’s Name: Joanne Lewis Date: February 26, 2010

Article title: Oral findings in asymptomatic (P-1) and symptomatic (P-2) HIV-infected children

Author(s): Agnes Del Toro, DDS, et al

Journal: Pediatric Dentistry

Volume (number): 18(2)

Month, Year: 1996

Major topic: oral manifestations of HIV in children

Type of Article: research

Main Purpose: to assess the relationship between HIV-related oral findings and HIV disease progression in perinatally HIV-infected children.

Overview of method of research: 28 HIV-infected children were selected for inclusion in the study: 13 females, 15 males ranging in age from 2 months to 13.5 years. All of the patients acquired HIV via maternal transmission and all were taking antiretroviral medication at the time of oral examination. 10 of the patients were classified as P-1 (asymptomatic) and 18 of the patients were classifies as P-2 (symptomatic) – CDC classification system.

Findings: The oral manifestations found in this population were pseudomembranous candidiasis, minor aphthous ulceration, delayed dental development, parotid swelling, and petechiae. 11 of the 28 patients (39.3%) had an oral finding; none of the 11 had more than 1 oral finding. 10% of the P-1 patients and 56% of the P-2 patients had an oral finding. The most common oral finding was pseudomembranous candidiasis.

Key points/Summary: Oral findings are common in pediatric HIV infection. Not surprisingly, P-2 patients have a significantly higher occurrence of oral findings than P-1 patients. Oral candidiasis is one of the most common oral complications of pediatric HIV infection.

Assessment of article: Clinically relevant – short and sweet.