Common Questions About HIV Lymphadenopathy

Lymph nodes are distributed throughout the body and support the immune system by filtering bacteria, viruses, and other microorganisms from the bloodstream. The particles are then killed by specialized white blood cells known as lymphocytes.

Any number of diseases can cause lymphadenopathy from strep throat to life-threatening cancers. The swelling is caused by the accumulation of lymphocytes as more and more cells are filtered through the glands.

Lymphadenopathy is not a sign of a malignancy. Rather, it is an indication of a robust immune response with the aim of controlling the infection.

Lymphadenopathy is common during early HIV infection. It is during this acute phase that the body is launching an immune defense to gain control over the virus. In some cases, this can take months or even years.

Lymphadenopathy during acute infection is 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 typically referred to as persistent generalized lymphadenopathy (PGL).

During early 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.

You should never assume that lymphadenopathy is the sign of a recent HIV infection. In some cases, lymphadenopathy isn't seen until the later stages of the disease and is more an indication of an associated infection such as tuberculosis or toxoplasmosis.

Lymphadenopathy occurring during chronic HIV infection will most often resolve when HIV treatment is started. During advanced infection, when the CD4 count has dipped below 100, the rapid involution of lymphadenopathy (meaning the lymph nodes return to normal without treatment) can be a sign of imminent immune collapse and a prelude to a serious opportunistic infection.

The one surefire way to treat HIV-associated lymphadenopathy is to start antiretroviral therapy. Not only does it actively suppress the virus, easing the burden on the lymphatic system, it helps maintain or restore immune function to better fight associated infections.

Until the lymphadenopathy is fully resolved, an over-the-counter nonsteroidal anti-inflammatory drug (NSAID) can be used to relieve swelling, tenderness, and pain.