Revised Surveillance Case Definition for HIV Infection

Since the first cases of acquired immunodeficiency syndrome (AIDS) were reported in the United States in 1981, surveillance case definitions for human immunodeficiency virus (HIV) infection (the cause of AIDS) and AIDS have undergone several revisions to respond to diagnostic advances.




CDC surveillance case definition laboratory criteria for HIV-1 infection

Persons ≥18 months and children <18 months born to HIV-negative mothers
HIV-infected (one of the following):
A multitest algorithm consisting of:

  • A positive HIV antibody or combination antigen/antibody test
  • An accompanying or subsequent positive result from a supplemental test different from the initial test

A positive result from a multitest HIV antibody algorithm from which only the final result was reported

A positive result or report of a detectable quantity from any of the following HIV virologic tests:

  • Qualitative HIV nucleic acid test (DNA or RNA)
  • Quantitative HIV nucleic acid test (viral load assay)
  • HIV-1 p24 antigen
  • HIV isolation (viral culture), or
  • HIV nucleotide sequence

Children <18 months born to mothers with HIV infection or unknown HIV status

HIV-infected (all three of the following):

Positive results on at least one specimen (not including cord blood) from any of the following HIV virologic tests:

  • HIV-1 NAT (DNA or RNA)
  • HIV-1 p24 antigen test, including neutralization assay for a child aged >1 month
  • HIV isolation (viral culture)
  • HIV nucleotide sequence (genotype)

The test date is known

One or both of the following:

  • Confirmation of the first positive result by another positive result on one of the above virologic tests from a specimen obtained on a different date; or
  • No subsequent negative result on an HIV antibody test, and no subsequent negative result on an HIV NAT before age 18 months




Definitively HIV-uninfected (both of the following)
No positive HIV NAT (RNA or DNA)
At least one of the following:

  • At least two negative HIV NATs from specimens on different dates at age ≥1 month of age, one of which was obtained at age ≥4 months
  • At least two negative HIV antibody tests from specimens obtained on different dates at age ≥6 months

Presumptively HIV-uninfected (all three of the following)
Does not meet criteria for definitively uninfected
Meets at least one of the following four laboratory criteria:

  • At least two negative NATs from specimens obtained on different dates at age ≥2 weeks, one of which was obtained at age ≥4 weeks
  • One negative NAT (RNA or DNA) at age ≥8 weeks
  • One negative HIV antibody test at age ≥6 months
  • If criteria for HIV infection had initially been met by one positive HIV NAT test, then it must have been followed by at least two negative results from specimens obtained on different dates, one of which is:
    • A NAT test from a specimen obtained at age ≥8 weeks, or
    • An HIV antibody test from a specimen obtained at age ≥6 months

No subsequent NAT

Indeterminate
Does not meet criteria for HIV-infected or HIV-uninfected (definitive or presumptive)

 

CDC: Centers for Disease Control and Prevention; HIV: human immunodeficiency virus; NAT: nucleic acid test.




References:

  1. Centers for Disease Control and Prevention (CDC). Revised surveillance case definition for HIV infection–United States, 2014. MMWR Recomm Rep. 2014 Apr 11;63(RR-03):1-10. [Medline]
  2. WHO case definitions of HIV for surveillance and revised clinical staging and immunological classification of HIV-related disease in adults and children. World Health Organization 2007

Created: Dec 21, 2018.

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