neobookRx
GuidelinesPrimary Care STG

HIV Infection in Children (<10 years old)

Please click on the link below to access the most up-to-date version of this guideline. The content on this page is currently being updated to align with the latest publication. Always check the version number at the bottom of the screen to confirm which version you are using. Click here to access the Primary Health Care - PHC Chapter 11: Human Immunodeficiency Virus and Acquired Immune Deficienc

Please click on the link below to access the most up-to-date version of this guideline. The content on this page is currently being updated to align with the latest publication. Always check the version number at the bottom of the screen to confirm which version you are using.

Click here to access the Primary Health Care - PHC Chapter 11: Human Immunodeficiency Virus and Acquired Immune Deficiency Syndrome (HIV and AIDS) - 26 February 2026

Description

Diagnosis in Children

WHO Clinical Staging of HIV and AIDS for Infants and Children

DESCRIPTION

HIV is a retrovirus affecting immune cells, especially CD4 T-lymphocytes. In advanced HIV disease the body loses its ability to fight infections and this is characterised by organ damage, opportunistic infections, malignancies and very low CD4 counts.

In infants and children, most infection is transmitted from mother to child. In adolescents and adults sexual spread is the usual cause.

Infants born of HIV-infected mothers may be:

  • HIV-infected,
  • HIV-exposed uninfected, or
  • HIV-exposed, unknown infection status (at risk of becoming HIV-infected).

For the purpose of the ART guidelines:

  • Children <10 years of age: follow the paediatric antiretroviral therapy (ART) guidelines.
  • Adolescents (10–19 years of age): follow the adult ART guidelines.

LoE:IIIb44

DIAGNOSIS IN CHILDREN

Testing must be done with counselling of parent/legal guardian/primary caregiver and, where appropriate, the child. The appropriate consent/assent should be obtained.

HIV TESTING IN CHILDREN

Table 11:7 part one

Figure 11:7 part two

Click on image to enlarge

If an HIV PCR test is indeterminate or discordant, refer to the National Department of Health Guidelines for prevention of Mother to Child Transmission of Communicable Infections, 2023.

Table 1: HIV testing in children

WHO CLINICAL STAGING OF HIV AND AIDS FOR INFANTS AND CHILDREN
https://iris.who.int/bitstream/handle/10665/69058/WHO_HIV_2005.02.pdf

Adapted WHO clinical staging of HIV and AIDS for infants and children
For persons ≤15 years of age with confirmed laboratory evidence of HIV infection

Clinical Stage 1

- asymptomatic
- persistent generalised lymphadenopathy (PGL)

Clinical Stage 2

- unexplained persistent weight loss
- hepatosplenomegaly
- papular pruritic eruptions
- extensive human papillomavirus infection
- extensive molluscum contagiosum
- fungal nail infections
- recurrent oral ulcerations
- lineal gingival erythema (LGE)
- unexplained persistent parotid enlargement
- herpes zoster
- recurrent or chronic RTIs, i.e.,
- otitis media
- otorrhoea
- sinusitis

Clinical Stage 3

- moderate unexplained malnutrition (not adequately responding to standard therapy)
- unexplained persistent diarrhoea (14 days or more)
- unexplained persistent fever (above 37.5°C, intermittent or constant, for longer than one month)
- persistent oral candidiasis (after first 6-8 weeks of life)
- oral hairy leukoplakia
- acute necrotising ulcerative gingivitis/periodontitis
- lymph node TB
- pulmonary TB
- severe recurrent bacterial pneumonia
- chronic HIV-associated lung disease including bronchiectasis
- symptomatic lymphoid interstitial pneumonitis (LIP)
- unexplained anaemia (< 8 g/dL), and or neutropaenia (< 500/mm3) and/or thrombocytopaenia (< 50 000/mm3) for more than one month

Clinical Stage 4

- unexplained severe wasting, stunting or severe malnutrition not adequately responding to standard therapy
- pneumocystis pneumonia
- recurrent severe presumed bacterial infections, e.g.
+ empyema
+ bone or joint infection
+ pyomyositis
+ meningitis
- but excluding pneumonia
- chronic herpes simplex infection (orolabial or cutaneous of more than one month’s duration or visceral at any site)
- extrapulmonary TB
- Kaposi’s sarcoma
- oesophageal candidiasis (or candidiasis of trachea, bronchi or lungs)
- CNS toxoplasmosis (outside the neonatal period)
- HIV encephalopathy
- CMV infection (CMV retinitis or infections of organs other than liver, spleen or lymph nodes; onset at age one month of more)
- extrapulmonary cryptococcosis including meningitis
- any disseminated endemic mycosis, e.g.
- extrapulmonary histoplasmosis
- coccidiomycosis
- chronic cryptosporidiosis
- chronic isosporiasis
- disseminated non-tuberculous mycobacteria infection
- HIV associated recto-vaginal fistula
- cerebral or B cell non-Hodgkin lymphoma
- progressive multifocal leukoencephalopathy (PML)
- HIV-associated cardiomyopathy or HIV-associated nephropathy

Table 2: WHO clinical staging for infants and children

Click here to access the pdf.

Standard Treatment Guidelines and Essential Medicines List for South Africa, Primary Healthcare, 2020-2024_Version 2.1_09 December 2024

Chapter 11: Human Immunodeficiency Virus and Acquired Immune Deficiency Syndrome (HIV AND AIDS)_ HIV Infection in Children (<10 years old)

NeoHealth® ID 34256 · updated 4/30/2026