Stage 4 HIV infection is recognised by:

• Severe failure to thrive or weight loss with a weight less than 60% of that expected for age
• Oesophageal candidiasis
• Pneumocystis pneumonia
• Disseminated tuberculosis or extrapulmonary tuberculosis
• HIV encephalopathy
• Many other severe opportunistic infections
• Malignancy

The main feature of stage 4 HIV infection is severe opportunistic infection such as Pneumocystis pneumonia. Unlike adults, children with HIV infection rarely present with malignancies.

A detailed description of the 4 stages of HIV infection are given at the end of this unit.