When Swollen Lymph Nodes Are a Sign of HIV

For many people, swollen lymph nodes, or lymphadenopathy may be an early sign of HIV infection. Swollen lymph nodes can be a feature of opportunistic infection or an AIDS-defining condition. Although there are many signs and symptoms that can prompt someone to get an HIV test, lymphadenopathy is often one of the first signs of viral infection. Enlarged lymph nodes can be present for three or more months and sometimes appear with no other signs of infection.  

What Are Lymph Nodes?

The lymphatic system is an important and often underappreciated network of tissues and organs within a larger body of organ systems. It is composed of:

• Lymphatic fluid
• Lymphatic vessels
• Lymphatic cells
• Lymphatic organs

The lymphatic cells include:

• Macrophages
• Dendritic cells
• Lymphocytes

The lymphatic system has three primary functions:

• Maintenance of fluid balance
• Facilitation of the absorption of dietary fats from the gastrointestinal tract to the bloodstream for metabolism or storage
• Enhancement and facilitation of the immune system

The lymphatic system, sometimes called the lymphoid system, allows for the immune system to function properly as it carries foreign invaders to lymph nodes, where they meet immune cells—like macrophages—that are ready to destroy and eliminate them from the body.

Lymph nodes are distributed in clusters throughout the body, describing some of the more prominent groupings:

• Axillary
• Cervical
• Inguinal
• Mediastinal
• Pulmonary
• Retroperitoneal
• Supraclavicular

Acute HIV Infection

Lymphadenopathy is common during the acute phase of HIV infection—also known as acute seroconversion or acute retroviral syndrome—affecting roughly 70% of newly infected individuals.

Swollen lymph nodes can pretty much occur anywhere there are lymph nodes in the body. They may appear at the front of the neck, the sides of the neck, behind your ears, under your chin, in your armpits, and even the crevices of your groin.

Enlarged lymph nodes may feel rubbery, moveable, and squishy. If there is redness, warmth, or tenderness that may be a sign of inflammation.

Sometimes lymph nodes may even be painful, but this is less common when lymph nodes are swollen as a result of HIV infection. 

 Common symptoms that may accompany lymphadenopathy include:

• Fever
• Swollen tonsils (tonsillitis)
• Sore throat
• Joint and/or muscle aches
• Rash
• Headache
• Diarrhea
• Fatigue

These signs and symptoms of acute HIV infection can begin a few days after you are exposed to the virus or many days after and usually last for about 14 days. Lymphadenopathy and accompanying symptoms can last for a few days or a few months and are often confused for other illnesses.

Lymphadenopathy in HIV is particularly unique in that the swollen lymph nodes are found throughout the body as opposed to one or two more localized areas as seen in conditions like the flu, herpes infections, staph infections, or solid tumor cancers. The phenomena of widespread lymphadenopathy is referred to as persistent generalized lymphadenopathy or PGL. 

Advanced HIV Infection

In some people, lymphadenopathy may resolve as they enter the chronic stage of infection. For others, PGL may last for months. The fact that they resolve does not mean the virus is inactive; it has simply established a “set point” where it continues to replicate and gradually depletes the immune system.

There are three phases of chronic HIV infection:

• Early: CD4 count over 500
• Intermediate: CD4 count 200–500
• Advanced: CD4 count under 200

Opportunistic infections are more likely when CD4 counts fall below 200 but they may occur at CD4 levels under 500. These infections are more common in those with chronic or untreated HIV because the virus depletes the immune system making it difficult to fight against disease.

Lymphadenopathy results when your compromised immune system is trying to fight an ever-widening range of opportunistic infections (OIs) but can’t keep up.

Different opportunistic infections may present with lymphadenopathy such as:

• Tuberculosis (TB): ccurs at 200–500 CD4 count
• Mycobacterium avium complex: Under 50 CD4 count
• Toxoplasmosis: Under 100 CD4 count
• Disseminated fungal infections: Under 200 CD4 count
• Atypical mycobacterial infections: Under 50 CD4 count
• Cytomegalovirus infection: Under 50 to 100 CD4 count
• Malignancy such as non-Hodgkin lymphoma (NHL): Under 200 CD4 count
• Herpes simplex virus (HSV): Under 350 CD4 count
• Herpes zoster virus (HZV): Under 200 CD4 count
• Invasive cervical cancer (ICC): Under 200 CD4 count

Antiviral therapy (ART) is commonly used to treat HIV and has therefore resulted in a decrease in OIs. By reducing the amount of HIV in the body, the immune system can remain strong and more adequately fight disease.

It is important to note that some people may develop OIs and PGL despite ART therapy. This is more common in those who were living with undiagnosed HIV for a long time and therefore have a weakened immune system and those who may not be taking the right combination of medication needed to keep HIV levels low enough for their immune system to fight OIs.

Immune Reconstitution Inflammatory Syndrome (IRIS)

Ironically lymphadenopathy can occur in those with HIV who respond to ART via a phenomenon known as immune reconstitution inflammatory syndrome (IRIS).

IRIS is observed in patients recovering from immunodeficiency and results in the unmasking of covert infections or the worsening of overt conditions after initiating ART. Little is known about why IRIS develops but researchers hypothesize that the condition has a paradoxical inflammatory component that results in:

• Fever
• Pneumonia
• Lymphadenopathy

IRIS is self-limiting, meaning the condition often resolves on its own. Corticosteroids like prednisone for one to two weeks is the treatment of choice and may lead to a quicker resolution of your symptoms.

Diagnosis and Treatment

If you are experiencing persistently swollen lymph nodes for six or more weeks you may want to contact a healthcare professional. They may advise you to get an HIV test.

They will also take a complete medical history that will include questions about:

• Previous sexual partners
• Intravenous drug use
• Other viral infections or sexually transmitted diseases
• Recent blood transfusions
• Occupational exposure to blood, like accidentally being stuck by needles

Prior to taking a physical exam, a healthcare professional may also ask you if you are experiencing any associated symptoms, such as:

• Fever
• Weight loss
• Muscle and joint aches
• Fatigue
• Headache

The physical exam will consist of checking the lymph nodes, examining the skin for rashes, and looking in the mouth for signs of candidiasis (white patches that signal infection with an opportunistic fungus).  

A biopsy of the lymph node may also be taken via a procedure called fine-needle aspiration cytology (FNAC) to identify the virus in question.

A Word from VeryWell

Swollen lymph nodes are common in many different medical conditions and may not signal HIV. In fact, if you are not engaging in high-risk sexual practices or drug use, your lymphadenopathy is unlikely to be caused by HIV. Even so, HIV testing may be considered if the condition persists for more than six weeks and presents on more than one part of the body such as the neck, groin, or armpits.

Currently, the USPSTF recommends screening for HIV infection in adolescents and adults aged 15 to 65 years, screening in younger adolescents and older adults at increased risk, and screening in all pregnant women.