4 Questions People Ask About HIV Lymphadenopathy

1
Why Are My Lymph Glands Swollen?

Doctor feeling patient's lymph nodes
Arthur Tilley/Getty Images

Lymphadenopathy is simply defined as an enlargement in the size or number of lymph nodes. Lymph nodes are specialized organs distributed throughout the body, which support the immune system by filtering bacteria, virus and other foreign particles from the bloodstream. These particles are then killed by special white blood cells called lymphocytes.

Any number of infections can cause lymphadenopathy, from simple strep throat to life-threatening cancers. The swelling itself is caused by a "back up" of lymphocytes as more and more cells filter through the glands during active infection.

The incidence of lymphadenopathy in people with HIV is especially high and can occur at any stage of infection. They most commonly present on either side of the neck or under the jaw, as well as in the armpits and groin. In some cases they can be extremely painful and visibly swollen, while at other they may more than tender than painful and barely noticeable except by touch.

Lymphadenopathy is not a sign of a malignancy (although malignancy can cause nodular swelling). It is rather it is the sign of robust response from the immune system to fight disease-causing agents.

2
How Long Will My Lymph Glands be Swollen?

Lymphadenopathy of the axilliary lymph nodes (nodes of the armpit). Dr. John Grey

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

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

If you have not been tested for HIV and the lymph glands remain swollen more than 2-4 week, see your doctor or visit your local clinic. The U.S. Preventive Services Task Force currently recommends that all Americans age 15-65 be tested for HIV as part of a routine doctor visit.

Sources:

U.S. Preventive Services Task Force (USPSTF). "Screening for HIV: U.S. Preventive Services Task Force Recommendation Statement." Rockville, Maryland; April 2013; accessed February 7, 2014.

3
Could Swollen Glands be a Sign of Something More Serious?

Neck lymphadenopathy associated with infectious mononucleosis. James Hellman, MD

During early stage HIV infection, lymphadenopathy is most often considered benign and self-limiting. That doesn't mean you should ignore it. Oftentimes, the duration and severity of the condition are directly related to the degree of immune suppression in the infected individual, commonly measured by the CD4 count.

One should never assume, however, that generalized lymphadenopathy is the sign of a recent HIV infection. In fact, some people don't have any noticeable signs until the later stages of the disease (known as the chronic phase). In cases such as these, generalized lymphadenopathy can be an indication of an associated or non-associated infection like mononucleosis (pictured), hepatitis B, tuberculosis or toxoplasmosis.

When localized (i.e., limited to one part of the body, such as the neck or groin), lymphadenopathy can be the sign of similarly localized disease or infection, ranging from a simple tooth abscess or skin infection to a sexually transmitted disease or extrapulmonary tuberculosis (i.e., TB presenting outside of the lungs).

Lymphadenopathy during chronic HIV infection will most often resolve when the underlying infection is treated.  During advanced infection, when the CD4 count drops below 100 cells/mL, the rapid involution of lymphadenopathy—meaning that the lymph nodes suddenly return to normal without treatment—can be a sign of immune collapse, as well as the likelihood of a serious opportunistic infection.

4
Can Lymphadenopathy be Treated?

Examination of axillary (armpit) lymph nodes. Amanda Mills, USCDCP

The one sure-fire way to treat HIV-associated lymphadenopathy is begin antiretroviral therapy (ART). Not only does ART actively suppress the virus, easing the burden on the lymphatic system, it helps to maintain or reconstitute immune function to better fight other associated infections.

Currently, it is recommended that ART be initiated in all patients, irrespective of CD4 count or stage of disease. According to studies, it not only reduces the risk of HIV-associated and non-HIV-associated illnesses by some 53%, it offers benefits in terms of longer life and a reduced risk HIV transmission.

An over-the-counter pain reliever can be used to soothe swollen lymph glands. This, along with warm compresses, may help reduce pain and swelling. While neither actively "treat" lymphadenopathy , they may complement ART by making the condition less painful.

Sources:

Department of Health and Human Services (DHHS). "Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents." Rockville, Maryland; accessed November 19, 2015.

National Institutes of Health (NIH). "Starting antiretroviral therapy early improves outcomes for HIV-infected individuals." Bethesda, Maryland; issued May 27, 2015.

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