4 Questions People Ask About HIV Lymphadenopathy

1
Why are my lymph nodes swollen?

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

Lymphadenopathy is the enlargement in the size or number of lymph nodes. 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 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.

The incidence of lymphadenopathy in people with HIV is especially high and can occur at any stage of infection. They most commonly develop on either side of the neck, under the jaw, or in the armpits and groin. In some cases, they can be painful and visibly swollen.

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.

2
How long will my lymph nodes be swollen?

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

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).

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

3
Could swollen glands be a sign of something worse?

Neck lymphadenopathy associated with infectious mononucleosis
Cervical (neck) iymphadenopathy. James Hellman, MD

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.

4
Can lymphadenopathy be treated?

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

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.

Currently, it is recommended that treatment be started on diagnosis irrespective of CD4 count or stage of disease. According to studies, it not only reduces the risk of illness by 53 percent, it offers benefits in terms of longer life and a reduced risk of transmission.

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

Sources:

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

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

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

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