Immunocompromised Definitions

Severely immunocompromised patients include:

  1. Patient with Stage 3 AIDS as defined by the Centers for Disease Control and Prevention (CDC) Guidelines when the immune system becomes severely compromised due to reduced CD4 T lymphocyte counts (<200) or opportunistic infection as defined by CDC1 see list of diseases below.
  2. Cancer patient undergoing immunosuppressive chemotherapy with febrile (Celsius 39) neutropenia (ANC <2000) OR severe neutropenia irrespective of fever (ANC <500)
  3. Rheumatoid arthritis with use of biologic disease modifying agents including tumor necrosis factor alpha or prednisone >10 mg per day. Methotrexate, Plaquenil not considered immunocompromising agents. 
  4. Solid organ transplant on immunosuppressants
  5. Inherited diseases of immunodeficiency (e.g., congenital agammaglobulinemia, congenital IgA deficiency)
  6. Bone marrow transplant recipient in one of the following phases of treatment:
    1. Pretransplantation period
    2. Preengraftment period (approximately 0-30 d posttransplantation)
    3. Postengraftment period (approximately 30-100 d posttransplantation)
    4. Late posttransplantation period (≥100 d posttransplantation) while still on immunosuppressive medications to prevent GVHD (typically 36 months post transplantation) (see Table reference below)

*Opportunistic illness in AIDS: (as per CDC2)

  1. Bacterial infections, multiple or recurrent*
  2. Candidiasis of bronchi, trachea, or lungs
  3. Candidiasis of esophagus
  4. Cervical cancer, invasive†
  5. Coccidioidomycosis, disseminated or extrapulmonary
  6. Cryptococcosis, extrapulmonary
  7. Cryptosporidiosis, chronic intestinal (>1 month's duration)
  8. Cytomegalovirus disease (other than liver, spleen, or nodes), onset at age >1 month
  9. Cytomegalovirus retinitis (with loss of vision)
  10. Encephalopathy attributed to HIV§
  11. Herpes simplex: chronic ulcers (>1 month's duration) or bronchitis, pneumonitis, or esophagitis (onset at age >1 month)
  12. Histoplasmosis, disseminated or extrapulmonary
  13. Isosporiasis, chronic intestinal (>1 month's duration)
  14. Kaposi sarcoma
  15. Lymphoma, Burkitt (or equivalent term)
  16. Lymphoma, immunoblastic (or equivalent term)
  17. Lymphoma, primary, of brain
  18. Mycobacterium avium complex or Mycobacterium kansasii, disseminated or extrapulmonary
  19. Mycobacterium tuberculosis of any site, pulmonary†, disseminated, or extrapulmonary
  20. Mycobacterium, other species or unidentified species, disseminated or extrapulmonary
  21. Pneumocystis jirovecii (previously known as "Pneumocystis carinii") pneumonia
  22. Pneumonia, recurrent†
  23. Progressive multifocal leukoencephalopathy
  24. Salmonella septicemia, recurrent
  25. Toxoplasmosis of brain, onset at age >1 month 
  26. Wasting syndrome attributed to HIV§

* Only among children aged <6 years.
† Only among adults, adolescents, and children aged ≥6 years.
§ Suggested diagnostic criteria for these illnesses, which might be particularly important for HIV encephalopathy and HIV wasting syndrome,1,3 

 

Citations:

  1. Centers for Disease Control and Prevention (CDC). 1993 Revised classification system for HIV infection and expanded surveillance case definition for AIDS among adolescents and adults. MMWR 1992;41(No. RR-17). 
  2. 2. Centers for Disease Control and Prevention (CDC) Revised surveillance case definition for HIV infection—United States, 2014. MMWR. Recommendations and Reports. 2014;63(3):1-10. 
  3. Centers for Disease Control and Prevention (CDC). 1994 Revised classification system for human immunodeficiency virus infection in children less than 13 years of age. MMWR 1994;43(No. RR-12). 



 

 

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