HIV and Swollen Lymph Nodes

Symptom seen in early infection and later-stage disease

Doctor feeling patient's lymph nodes
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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 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). It is not a sign of a malignancy or tumor but rather the indication of a robust response from the immune system.

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, of course, 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.

Source:

Cainelli, F.; Vallone, C.; Tanko, M. et al. "Lymph nodes and pathogenesis of infection with HIV-1." Lancet Infectious Diseases. 2015; 10(2):71-72.

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