From the Research
HIV causes widespread lymphadenopathy primarily because it directly infects and replicates within CD4+ T lymphocytes and other immune cells that are abundant in lymph nodes, triggering an intense immune response and disrupting the normal architecture of lymph nodes. This response includes proliferation of B and T lymphocytes and increased production of inflammatory cytokines, causing lymph nodes to enlarge 1. The lymphadenopathy is typically generalized, affecting multiple lymph node regions, and may be more prominent during acute infection and again during advanced disease. As the infection progresses, the body attempts to contain the virus by trapping it within lymph nodes, leading to further enlargement. The virus disrupts the normal architecture of lymph nodes by destroying follicular dendritic cells that maintain lymph node structure, which serves as a major reservoir for the virus throughout the course of infection 2.
Some of the key causes of lymphadenopathy in HIV-infected patients include:
- Infectious causes, such as tuberculous and nontuberculous mycobacterial infections and HIV infection itself
- Reactive causes, such as immune reconstitution syndrome and Castleman disease
- Neoplastic causes, such as lymphoma and Kaposi sarcoma 1, 3. It is essential to consider patients' demographic characteristics, clinical presentations, CD4 lymphocyte counts, and radiologic features to identify likely causes of lymphadenopathy 1.
The most recent and highest quality study on this topic, published in 2021, highlights the importance of considering the various causes of lymphadenopathy in HIV-infected patients and the need for a comprehensive approach to diagnosis and management 1. Therefore, it is crucial to prioritize a thorough diagnostic workup, including imaging and laboratory tests, to determine the underlying cause of lymphadenopathy in HIV-infected patients.