What are the other Names for this Condition? (Also known as/Synonyms)

• Enlarged Lymph Nodes due to HIV Infection
• HIV Lymphadenitis
• Human Immunodeficiency Virus Lymphadenopathy

What is HIV Lymphadenopathy? (Definition/Background Information)

• HIV Lymphadenopathy is the inflammation and enlargement of lymph nodes due to underlying HIV infection, which is caused by the human immunodeficiency virus (HIV)
• The virus gradually destroys the body’s immune system. The infection is usually acquired through sexual intercourse, or exposure to infected blood or body fluids
• The signs and symptoms of HIV Lymphadenopathy include enlarged lymph nodes that are painless (and seen in at least 2 areas of the body). HIV infection is characterized by a host of symptoms that include fever, inflammation of throat, rashes, muscle aches, mouth and esophageal sores, headache, nausea, vomiting, weight loss, and neurological symptoms
• Treatment measures of HIV Lymphadenopathy include treating the underlying infection through medications (HAART therapy), education, and following healthy lifestyle measures
• The prognosis of HIV Lymphadenopathy generally depends upon the severity of the signs and symptoms due to the underlying HIV infection and on one’s response to treatment

Who gets HIV Lymphadenopathy? (Age and Sex Distribution)

HIV Lymphadenopathy occurs due to underlying HIV infection, which can affect individuals of all ages, both genders (males and females), and all racial and ethnic groups.

What are the Risk Factors for HIV Lymphadenopathy? (Predisposing Factors)

The key risk factor for HIV Lymphadenopathy is the underlying HIV infection. Following are the risk factors for HIV infection:

• Individuals who have a history of sexually-transmitted diseases
• Sexual partners of those who are infected with HIV infection
• Victims of sexual assault
• Individuals who have unprotected sex
• Men and women who have sex with multiple partners; who have sex for money
• Men-men sex
• Injection drug users who share needles

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of HIV Lymphadenopathy? (Etiology)

• HIV Lymphadenopathy is caused by a viral infection that results in swollen lymph nodes and other related signs and symptoms.
• The infection is caused by the human immunodeficiency virus (HIV), a virus which attacks and gradually destroys the immune system
• The virus spreads in the following manner:
  • Sexual contact
  • Contaminated blood transfusions and blood products
  • Injections given to patients using contaminated needles and syringes
  • An infected pregnant mother can pass on the virus to the fetus through the placenta (transplacental or vertical infection)
  • In some rare cases, the virus can spread while breastfeeding
• After initial infection stage, there may be no evidence of the disease for (about) 10 years; this stage is called asymptomatic HIV infection

What are the Signs and Symptoms of HIV Lymphadenopathy?

In HIV-infected individuals, the lymphadenopathy may occur in the following manner:

• In 50% of the HIV-infected individuals, it is due to reaction of HIV
• In 43% of them, it is HIV-related lymphoid malignancy (such as lymphomas)
• In the remaining 7%, it is due to HIV-associated secondary infections

The signs and symptoms of HIV Lymphadenopathy may include:

• Lymphadenopathy or enlarged lymph nodes
• The swollen lymph nodes are generally painless
• Chronic lymphadenopathy syndrome in HIV-positive patients: Enlargement of the lymph nodes that takes place in a minimum of 2 areas of the body, for a period of 3 months or more (specifically not including the groin area)

The associated signs and symptoms of underlying HIV infection depend upon the health of the individual affected and the severity of infection. Acute HIV infection occurs 2-4 weeks after infection with the human immunodeficiency virus (HIV virus), and 50% of the affected individuals develop signs and symptoms.

The common signs and symptoms associated with acute HIV infection may include:

• Fever, which is usually 101 deg. F with headache
• Fatigue and lethargy with muscle aches or muscle stiffness
• Loss of appetite and weight loss
• Lymph nodes gets swollen
• Sore throat with dry cough
• Nausea, vomiting, or diarrhea
• Heavy sweating in the nights
• Rashes on skin
• Ulcers of the mouth and esophagus

All these symptoms resemble and are often confused with the symptoms of other viral diseases such as flu, mononucleosis, or strep throat. When the HIV infection reaches an advanced stage, the signs and symptoms exhibited may include:

• Candidiasis of the mouth with cream-colored, raised patches in the mouth and soreness
• Easy bleeding

How is HIV Lymphadenopathy Diagnosed?

The healthcare provider may make a diagnosis of HIV Lymphadenopathy based on the following exams and procedures:

• Complete physical examination with medical history review; the physical examination may involve a study of the signs and symptoms
• Antibody test or HIV ELISA or Western Blot test: The most common test performed is the antibody test. Enzyme immunoassay (EIA) or ELISA is used to check for the antibodies produced in the body against HIV virus
• HIV RNA test/Viral Load test: This test is done to assess the virus itself called as HIV RNA or viral load. This test will help in detecting the HIV virus. It is an important test for diagnosing those who are recently infected
• A negative antibody test and a positive RNA test can help strongly confirm the acute HIV infection
• Low levels of CD4 (white blood cell) count could be taken as an indication of suppressed immune system

In majority of the cases, a lymph node biopsy is not performed for HIV Lymphadenopathy. However, if the signs and symptoms persist despite suitable treatment, then a biopsy may be undertaken to rule-out other causes of swollen glands (such as a lymphoma).

In case of a lymph node biopsy, the following information may be noted:

• Lymph node biopsy: A lymph node biopsy is performed and sent to a laboratory for a pathological examination. The pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis. The pathologist may use special techniques, such as immunohistochemistry stains, to help reveal the presence of the pathogen
• The lymph node biopsy may be performed through any of the following procedures:
  • Fine needle aspiration biopsy (FNAB): A device called a cannula is used to extract tissue or fluid from the lymph nodes
  • Lymph node core biopsy of the enlarged lymph node
  • Lymph node open biopsy of the enlarged lymph node

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of HIV Lymphadenopathy?

The following are the possible complications that can arise due to acute HIV Infection causing Lymphadenopathy:

• AIDS or acquired immunodeficiency syndrome
• Autoimmune diseases
• Cancer that may include Kaposi’s sarcoma and lymphomas (HIV-associated lymphomas)

How is HIV Lymphadenopathy Treated?

The management of HIV Lymphadenopathy includes undertaking treatment of the underlying HIV infection. Treatment for HIV infection should begin with educating the patient about the disease and its treatment, so that they will cooperate with their healthcare provider during treatment.

• Symptomatic treatment is given for fever and pain to ease discomfort
• Highly active antiretroviral treatment (HAART) is a combination of 2-3 medications and is given to treat HIV infection. However, controversies still prevail regarding the use of HAART to slow down the progressive nature of the disease, because these drugs have many side effects. The physician usually decides on the commencement of HAART based on the patient's health status

Individuals with acute HIV Infection should also follow the following measures:

• Avoid exposure to individuals with infectious diseases
• Avoid places and areas that can make one feel depressed
• Consume a well-balanced nutritious diet with enough calories
• Follow an exercise regimen as advised by the physician and/or therapist, avoiding exhaustion
• Minimize stress
• Practice safe sex

How can HIV Lymphadenopathy be Prevented?

The preventative measures for HIV Lymphadenopathy includes taking proper precautions to prevent transmission of the harmful virus. Currently, there are no definitive methods available to prevent acute HIV infection. However, the following measures may be considered:

• Practicing safe sex; avoid unprotected sexual intercourse
• Avoid sex with multiple partners
• Avoid injection (illegal) drugs and avoid sharing the needles and syringes
• Those who have tested positive for AIDS should not donate blood, plasma, body organs or sperm. 
• HIV infected individuals should go for regular testing

All these factors can contribute in avoiding HIV infection, and consequently, HIV Lymphadenopathy.

What is the Prognosis of HIV Lymphadenopathy? (Outcomes/Resolutions)

The prognosis of HIV Lymphadenopathy is based on the severity of the underlying HIV infection.

• Prompt treatment methods will help improve the quality of life of HIV-infected individuals and help delay the onset of AIDS
• The effectiveness of treatments performed for early symptomatic HIV disease may vary. Some infections and diseases are easier to treat with medications than others

Additional and Relevant Useful Information for HIV Lymphadenopathy:

• Acute HIV infection need not necessarily proceed to early symptomatic HIV infection and to advanced HIV disease known as AIDS. But in a majority of cases, acute HIV infection does proceed to the advanced stage i.e. AIDS

General information on lymph nodes:

The lymph nodes are part of one’s immune system. The lymph nodes are present throughout the body, usually in groups. In normal healthy adults, one cannot feel (see or touch) the lymph nodes readily. However, if they are enlarged, they can be felt either by the individual himself/herself or by the healthcare provider.

Enlarged lymph nodes can occur in both benign and malignant conditions. Hence, the cause of enlarged lymph nodes should be evaluated. If no obvious cause for enlargement of lymph nodes is found, then the possibility of a lymph node malignancy should be ruled out.

In a majority of individuals, a lymph node swelling is caused by a benign process such as an inflammation or infection. In many cases, swollen lymph nodes are part of other signs and symptoms. This can help a healthcare provider arrive at a list of follow-up tests and ensure an accurate diagnosis. Superficial enlarged lymph nodes can be felt by the healthcare provider through palpation. Enlarged lymph nodes deep in the body are often detected by radiological studies such as X-rays, ultrasound scan, CT and MRI scans.

Some enlarged lymph nodes can be painful, while others may be painless. Depending upon the underlying cause, enlarged lymph nodes can be localized to a particular area of the body, or they can be generalized, meaning that they are present throughout the body.