Page 79 - AIDSBK23C

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DEFINITIVE DIAGNOSTIC METHODS FOR DISEASES INDICATIVE OF AIDS

The conditions listed above under Category C may be diagnosed by a variety of methods,
depending upon the nature of the disease and the diagnostic methods available. These conditions
and the definitive methods are delineated below and in Table 4.
The following diseases are definitively diagnosed by microscopy (histology or cytology):
cryptosporidiosis, isosporiasis, Kaposi's sarcoma, lymphoma, lymphoid pneumonia (lymphocytic
interstitial pneumonitis) or hyperplasia, Pneumocystis jiroveci (carinii) pneumonia, progressive
multifocal leukoencephalopathy, toxoplasmosis, cervical cancer.
Candidiasis is definitively diagnosed by: Gross inspection by endoscopy or autopsy, or
by microscopy (histology or cytology) on a specimen obtained directly from the tissues affected
(including scrapings from the mucosal surface), not from a culture.
The following diseases are definitively diagnosed by microscopy (histology or cytology),
culture, or detection of antigen in a specimen obtained directly from the tissues affected or a
fluid from those areas: coccidioidomycosis, cryptococcosis, cytomegalovirus, herpes simplex
virus, histoplasmosis.
The following diseases are diagnosed definitively by culture: tuberculosis, other
mycobacteriosis, salmonellosis, and other bacterial infection.
HIV encephalopathy (AIDS dementia) is diagnosed by clinical findings of a disabling
cognitive and/or motor dysfunction interfering with occupation or activities of daily living, or
loss of behavioral developmental milestones affecting a child, progressing over weeks to months,
in the absence of a concurrent illness or condition other than HIV infection that could explain the
findings. Methods to rule out such concurrent illnesses and conditions must include
cerebrospinal fluid examination, and either brain imaging (computerized tomography or
magnetic resonance imaging) or autopsy.
HIV wasting syndrome ("slim disease") is diagnosed by findings of profound involuntary
weight loss greater than 10% of baseline body weight plus either chronic diarrhea (2 or more
loose stools per day for 30 or more days) or chronic weakness and documented fever (for 30 or
more days, intermittent or constant) in the absence of a concurrent illness or condition other than
HIV infection that could explain the findings (such as cancer, tuberculosis, cryptosporidiosis, or
other specific enteritis).
Recurrent pneumonia is diagnosed definitively by the finding of recurrence (more than
one episode of pneumonia in a 1 year period), acute onset (new radiographic evidence not
present earlier) of pneumonia diagnosed by both a) culture (or other organism-specific diagnostic
method) obtained from a clinically reliable specimen of a pathogen that typically causes
pneumonia (other than Pneumocystis jiroveci (carinii) or Mycobacterium tuberculosis), and b)
radiologic evidence of pneumonia; cases that do not have laboratory confirmation of a causative
organism for one of the episodes of pneumonia will be considered to be presumptively
diagnosed.