HIV and Swollen Lymph Nodes

Symptom seen in early infection and later-stage disease

Doctor feeling patient's lymph nodes

Arthur Tilley / Getty Images

One of the more common symptoms of HIV is lymphadenopathy, a swelling of the lymph nodes in the armpits (axillary nodes), groin (inguinal nodes), neck (cervical nodes), chest (mediastinal nodes), and abdomen (abdominal nodes).

While the swelling may be directly related to HIV, particularly in the early stages, it can also be a result of both HIV- and non-HIV-associated infections in later disease.

Anatomy of Lymph Nodes

Lymph nodes are small, bean-sized organs distributed throughout the body that are part of the immune system. Lymph, a clear-to-white fluid containing infection-fighting immune cells, is filtered through the lymph nodes through a network of tiny capillaries. It is in the nodes that the lymph is cleansed before returning back into circulation.

The lymphatic system comprises not only the lymph nodes but the spleen, thyroid, tonsils, adenoids, and lymphoid tissues.

Causes of Lymphadenopathy

Lymphadenopathy is a characteristic sign of early HIV and a feature of many later-stage opportunistic infections (OIs). Lymphadenopathy is not typically a symptom of a malignancy, but Hodgkin's lymphomas can present in people with advanced HIV.

During early acute infection, as lymph passes through the lymph nodes, a host of immune cells and other microbes will begin to accumulate within the glands. This can cause the system to effectively back up, causing the nodes to swell, sometimes to unsightly proportions.

Lymphadenopathy can happen in one or multiple parts of the body, the pattern of which can tell us a lot about what is going on.

  • Localized lymphadenopathy is the swelling of lymph nodes in a specific part of the body, most likely due to a nearby infection.  Examples include a throat infection that causes the swelling of cervical nodes or a chlamydial infection that causes the swelling of inguinal nodes.
  • Generalized lymphadenopathy is the widespread swelling of lymph nodes throughout the body, suggesting a systemic, all-body infection such as the flu, infectious mononucleosis, tuberculosis, toxoplasmosis, leukemia, and HIV.
  • Persistent generalized lymphadenopathy (PGL) is a type that persists, often with no apparent cause. It is usually an indication of an untreated chronic infection such as hepatitis and HIV. PGL can persist for months or even years.

Sometimes the lymph nodes themselves can become inflamed and infected. This is frequently referred to as lymphadenitis.

Symptoms of Lymphadenopathy

Swollen lymph nodes may or may not be visible. In fact, discomfort and pain are often the first signs of lymphadenopathy before actual swelling begins. Even if they aren't readily apparent, you can usually feel the enlarged nodes under an armpit, around the neck, behind the ears, or in the groin.

In some cases, you may feel a single, enlarged node. At other times, there may be a cluster of swollen glands located on multiple parts of the body.

While the lymph nodes are often tender and painful, they can sometimes be entirely painless. The skin covering the nodes may also be red and warm to the touch. Fever can accompany, particularly during acute infection.

Treating Lymphadenopathy

For people with HIV, the first and foremost means of treating lymphadenopathy is antiretroviral therapy. By completely suppressing HIV to undetectable levels, the stress on the lymph nodes can be greatly reduced. Lymphadenopathy will usually disappear within a few weeks or months once treatment is started.

Even if the lymphadenopathy is caused by an OI, antiretroviral therapy is still considered a must. By treating the OI while suppressing HIV with antiretroviral medications, a person will stand a far better chance of restoring immune function and preventing future infections.

If the lymphadenopathy in especially painful, an over-the-counter nonsteroidal anti-inflammatory drug (NSAID) like ibuprofen may help. This, along with a warm compress, can help reduce any inflammation or swelling.

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  1. Karpf M. Lymphadenopathy. In: Walker HK, Hall WD, Hurst JW, editors. Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd edition. Boston: Butterworths; 1990. Chapter 149. Available from: https://www.ncbi.nlm.nih.gov/books/NBK256/

  2. Willard-Mack CL. Normal structure, function, and histology of lymph nodesToxicol Pathol. 2006;34(5):409–424. doi:10.1080/01926230600867727

  3. Null M, Agarwal M. Anatomy, Lymphatic System. [Updated 2019 Jun 22]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK513247/

  4. Choi I, Lee S, Hong YK. The new era of the lymphatic system: no longer secondary to the blood vascular systemCold Spring Harb Perspect Med. 2012;2(4):a006445. doi:10.1101/cshperspect.a006445

  5. Justiz Vaillant AA, Naik R. HIV-1 Associated Opportunistic Infections. [Updated 2019 Nov 28]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK539787/

  6. Alberts B, Johnson A, Lewis J, et al. Molecular Biology of the Cell. 4th edition. New York: Garland Science; 2002. Lymphocytes and the Cellular Basis of Adaptive Immunity. Available from: https://www.ncbi.nlm.nih.gov/books/NBK26921/

  7. Children’s Hospital of Philadelphia. Lymphadenopathy. chop.edu

  8. Freeman AM, Matto P. Adenopathy. [Updated 2019 Nov 27]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK513250/

  9. Afzal W, Arab T, Ullah T, Teller K, Doshi KJ. Generalized Lymphadenopathy as Presenting Feature of Systemic Lupus Erythematosus: Case Report and Review of the LiteratureJ Clin Med Res. 2016;8(11):819–823. doi:10.14740/jocmr2717w

  10. Baroni CD, Vitolo D, Uccini S. Immunohistopathogenesis of persistent generalized lymphadenopathy in HIV-positive patientsRic Clin Lab. 1990;20(1):1–10. doi:10.1007/bf02910143

  11. Stanford Children’s Health. Lucile Packard Children’s Hospital Stanford. Lymphadenopathy. stanfordchildrens.org 

  12. Gill PS, Arora DR, Arora B, et al. Lymphadenopathy--An Important Guiding Tool for Detecting Hidden HIV-Positive Cases: A 6-Year StudyJ Int Assoc Physicians AIDS Care (Chic). 2007;6(4):269–272. doi:10.1177/1545109707304298

  13. Haq I, Moss K, Morris VH. Myalgia with lymphadenopathyJ R Soc Med. 2001;94(10):521–522. doi:10.1177/014107680109401008

  14. Kemnic TR, Gulick PG. HIV Antiretroviral Therapy. [Updated 2019 Nov 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK513308/

  15. Seok, H., Jeon, J.H., Oh, K.H. et al. Characteristics of residual lymph nodes after six months of antituberculous therapy in HIV-negative individuals with cervical tuberculous lymphadenitisBMC Infect Dis 19, 867 (2019). https://doi.org/10.1186/s12879-019-4507-0

  16. Günthard HF, Saag MS, Benson CA, et al. Antiretroviral Drugs for Treatment and Prevention of HIV Infection in Adults: 2016 Recommendations of the International Antiviral Society-USA PanelJAMA. 2016;316(2):191–210. doi:10.1001/jama.2016.8900

  17. Sleigh BC, Manna B. Lymphedema. [Updated 2019 Dec 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK537239/

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