Common Questions About HIV Lymphadenopathy

Lymphadenopathy is a medical term used to describe the enlargement in the size and/or number of lymph nodes. Lymphadenopathy is common in people with HIV and can occur at any stage of the infection.

In people with HIV, lymphadenopathy most commonly develops on either side of the neck, under the jaw, or in the armpits or groin. In some cases, the nodes can be extremely painful and as large as a walnut.

1

Why Causes Lymphadenopathy?

Cervical lymphadenopathy

 Coronation Dental Specialty Group / Wikimedia Commons

Lymph nodes are distributed throughout the body and support the immune system by filtering bacteria, viruses, and other disease-causing microorganisms (pathogens) from the lymphatic system. The pathogens are then killed by specialized white blood cells known as lymphocytes.

Lymphadenopathy can be generalized (affecting large parts of the body) or regional (affecting only a part of the body). The causes can vary and may include infections, medications, autoimmune diseases, and cancer.

Generalized
  • HIV

  • Acute lymphoblastic leukemia (ALL)

  • Acute myeloblastic leukemia (AML)

  • Gaucher disease

  • Graft-versus-host disease (GvHD)

  • Hodgkin lymphoma

  • Rheumatic arthritis

  • Sarcoidosis

  • Syphilis

  • Tuberculosis

  • Typhoid fever

Regional
  • Colds, flu, and other upper respiratory infections

  • Gingivitis

  • Herpes viruses

  • Infectious mononucleosis

  • Kawasaki disease

  • Leukemia

  • Non-Hodgkin lymphoma

  • Otitis media (middle ear infections)

  • Solid tumor malignancies (cancers)

  • Staphylococcal skin infections

  • Streptococcal pharyngitis (strep throat)

Whatever the underlying cause, lymphadenopathy is triggered by the filtration of pathogens in the lymph nodes. This instigates an inflammatory response in which lymphocytes and other immune cells are recruited to kill the invaders.

If there is a local infection like strep throat, the swelling may only involve nearby lymph nodes (such as the cervical lymph nodes in the neck). If there is a systemic infection like HIV, clusters of lymph nodes throughout the body may be affected.

As uncomfortable and unsightly as lymphadenopathy can be, it is not the sign of immune failure. Rather, it is an indication of a robust immune response as the body fights anything it considers to be foreign or harmful.

2

Is Lymphadenopathy a Sign of HIV?

Woman palpating lymph node
BSIP / Getty Images

Lymphadenopathy is common during the acute (early) stage of HIV. It is during this phase that the body launches an immune defense to gain control over the virus. It can usually do so within weeks or months, at which point the virus will level off and enter the chronic (persistent) stage of infection.

Lymphadenopathy during an acute HIV infection is most often generalized, meaning that it occurs in two or more sites in the body. When the nodes are larger than two centimeters (roughly an inch) and last for more than three months, the condition is referred to as persistent generalized lymphadenopathy (PGL).

Although lymphadenopathy can occur for any number of reasons, PGL is a stronger indication that HIV is involved.

As a rule of thumb, you should get tested for HIV if the following occurs:

  • Your lymph glands remain swollen for more than two to four weeks.
  • The swelling continues even after any signs of illness have cleared.
  • You are sexually active or an injecting drug user.

The U.S. Preventive Services Task Force currently recommends that all Americans ages 15 to 65 be tested for HIV as part of a routine doctor visit.

3

Is Lymphadenopathy Dangerous?

Woman with a sore throat holding her neck, On gray Background, Lymphadenopathy, People with health problem concept.
Tharakorn / Getty Images

During acute HIV infection, lymphadenopathy is most often benign and self-limiting. Oftentimes, the duration and severity of the condition are directly related to the degree of immune suppression (as measured by the CD4 count). In short, the weaker the immune response, the more extensive or severe the swelling will be.

But not always.

In some cases, lymphadenopathy doesn't develop until the chronic stage when the immune system is fully compromised. It is at this point that opportunistic infections like tuberculosis or toxoplasmosis can develop.

In this context, lymphadenopathy is anything but benign. If not treated aggressively, opportunistic infections like these can quickly disseminate (spread), manifesting with generalized lymphadenopathy, severe multi-organ symptoms, and an increased risk of death.

It is important to remember that lymphadenopathy is not a disease but a symptom of a disease. It can occur during the acute or chronic stage of HIV and mean entirely different things based on when the symptom develops.

4

Can Lymphadenopathy Be Treated?

Close-up of a young man taking nutritional supplement pills
Letizia Le Fur / Getty Images

If left untreated, lymphadenopathy can resolve after an acute infection within weeks or months. With that said, HIV is never left untreated. Even if the CD4 count is normal (500 or above), HIV is still treated without exception.

In the end, the one surefire way to resolve HIV-associated lymphadenopathy is to start antiretroviral therapy (ART). Not only does ART actively suppress the virus, but it also helps maintain or replenish the immune response to better prevent HIV-associated infections.

Even in people with advanced HIV (CD4 counts under 100), ART can dramatically restore the immune response and reduce the risk of illness and death.

According to a 2015 study published in the New England Journal of Medicine, the early treatment of HIV reduces the risk of serious illness and death by 53% while extending life expectancy to near-normal levels.

Until the lymphadenopathy symptom are fully resolved, an over-the-counter nonsteroidal anti-inflammatory drug (NSAID) like Advil (ibuprofen) can be used for the occasional relief of pain, tenderness, and swelling.

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