Lymphadenopathy - Swollen Lymph Nodes and HIV

A Common Symptom That Is Considered an Important Indicator of HIV Infection

Cervical lymphadenopathy presenting with a single, enlarged lymph node.. Photo Credit: National Institutes of Health (NIH)

One of the more common symptoms associated with HIV infection is lymphadenopathy, a swelling of the lymph nodes of the armpits (axillary), groin  (inguinal), neck (cervical), chest (mediastinal), and abdomen (abdominal). While the swelling can often be directly attributed to HIV—or more specifically the body's reaction to HIV—it can also be a result of both associated and  non-associated infections, some of which may be  serious.

What are Lymph Nodes?

Lymph nodes are small, bean-sized organs of the immune system, which are distributed  throughout the body. Lymph fluid, the substance of which collects foreign bodies tissues, is filtered through the lymph nodes through a system of capillaries, cleansing the fluid before returning it back into circulation.

This circulatory function is described as the lymphatic system and comprises not only the lymph nodes but the spleen, thyroid, tonsils, adenoids and other lymphoid tissues.

What Causes Lymphadenopathy?

Lymphadenopathy is recognized as a common sign of infection and is considered an important diagnostic indicator of HIV.

During an infection, when lymphatic fluid passes through the lymph nodes, a host of immune cells and other substances are filtered out and begin to accumulate within the nodes. This can cause the system to effectively back up, causing the lymph nodes to swell profoundly, sometimes to unsightly proportions.

Lymphadenopathy can manifest in a number of ways, the presentation of which can tell us a lot about what type of infection it may or may not be.

  • Localized lymphadenopathy is the swelling of lymph nodes in a specific part of the body, most likely due to nearby infections. Examples include a dental abscess or throat infection that causes the swelling of cervical lymph nodes, or a chlamydial infection that causes the swelling of inguinal lymph 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, hepatitis, tuberculosis, toxoplasmosis, leukemia, lymphoma, histoplasmosis and, of course, HIV.
     
  • Persistent generalized lymphadenopathy is one that persists with no apparent cause. This is most generally indicative of a chronic infectious disease such as untreated hepatitis and untreated HIV, both of which can progress gradually over time (often with minimal symptoms) until other, more serious conditions appear.

Sometimes the lymph nodes themselves can become inflamed and infected. This is frequently referred to as lymphadenitis, although many consider the two terms interchangeable.

What are the Symptoms of Lymphadenopathy?

Swollen lymph nodes may or may not always be visible. In some cases, discomfort and pain are the first signs of lymphadenopathy, the identification of which can only be made by physical examination.

Usually, one can feel enlarged lumps under the armpit, around the neck, behind the ears, in the groin. etc. In some cases, one might feel a single, enlarged node, while at others times there might be a cluster of swollen glands on one or multiple sites of the body.

While the lymph nodes can often be tender and painful, in some cases they may be entirely painless. Oftentimes, the skin cover the lymph nodes may be red and warm to the touch. Fever can also accompany, particularly during an acute infection.

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Is There a Treatment for Lymphadenopathy?

For people with HIV, the one, primary facet of treatment for lymphadenopathy is antiretroviral therapy. By preventing the replication of HIV and lowering the viral burden, the strain on the lymph nodes can be profoundly reduced. Typically, the condition can resolve within a few months once treatment is started.

Even if other causes for lymphadenopathy are identified, the initiation of HIV therapy is still considered a must and should accompany treatment of the concomitant (co-existing) infection.

Edited by James Myhre and Dennis Sifris, M.D.

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