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June 9, 1993

Effects of New 1993 Criteria for Classification of AIDS

Author Affiliations

Stanford University School of Medicine Palo Alto, Calif

JAMA. 1993;269(22):2846-2847. doi:10.1001/jama.1993.03500220032013

To the Editor.  —On January 1,1993, the revised classification system for human immunodeficiency virus (HIV) infection and expanded surveillance case definition for acquired immunodeficiency syndrome (AIDS) went into effect.1 With the new criteria, individuals with a CD4 cell count of less than 0.20×109/L (200/μL) or a CD4 percentage of less than 14% are classified as having AIDS even in the absence of a defining opportunistic infection or indicator disease. The list of defining conditions was augmented by inclusion of pulmonary tuberculosis, bacterial pneumonia, and cervical cancer. Many implications for insurance coverage, clinic eligibility, and other social factors, as well as medical ones, result from this change. For example, it may be anticipated that survival for AIDS patients will artificially increase, and the point prevalence of disability and decreased quality of life in AIDS patients will become somewhat less. It is important to recognize the magnitude of these