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We evaluated the usefulness of both the Walter Reed (WR) staging classification and the component criteria used in the system in predicting progression to AIDS. The WR classification was applied to a cohort of 431 men who were seropositive for the human immunodeficiency virus on entry into a prospective study. The WR classification was of limited usefulness, as only 133 men (31%) could be assigned to a WR stage. Among men who could be WR classified, only individuals in WR stage 5 were found to have a significantly more rapid progression to AIDS. The seropositive cohort was also classified based on initial CD4 cell number. Low CD4 counts (less than 400 cells/mm3) were significantly associated with progression to AIDS, and grouping seropositive men by CD4 number alone provided as much prognostic information as the WR classification. Skin test anergy was also a significant predictor for progression to AIDS, but only in individuals with low CD4 counts.

HIV infection is a global problem, with the largest number of cases occurring in the United States. HIV affects men, women, and children with varying frequency in different parts of the world. The spectrum of HIV infection and its consequences is broad. HIV, a retrovirus, is responsible for gradual and progressive damage to the human immune system. Over the course of years (more than 7 in many), the resultant deficiency in cell-mediated immunity leaves the host susceptible to infections, malignancies, and possible neuropsychiatric abnormalities. Current efforts to better understand this virus, its interaction with the human immune system, its clinical consequences, and its detection will continue to bring us closer to finding effective means of preventing and treating HIV infection. In addition, an understanding of the epidemiology, immunopathogenesis, and clinical consequences of HIV infection will contribute to a more knowledgeable approach to caring for HIV-infected individuals and anticipating their many needs.