Lymph nodes & spleen, nonlymphoid
Lymph nodes-infectious / parasitic disorders

Topic Completed: 1 August 2013

Minor changes: 29 July 2020

Revised: 4 February 2019, last major update August 2013

Copyright: 2003-2020,, Inc.

PubMed Search: HIV [title] lymph nodes [title]

Nat Pernick, M.D.
Page views in 2019: 3,356
Page views in 2020 to date: 2,095
Cite this page: Pernick N. HIV. website. Accessed August 10th, 2020.
Definition / general
Clinical features
  • In non-TB endemic region, causes of peripheral lymphadenopathy in HIV+ patients are reactive (50%), malignancy (43%), infection (7%, 3% TB) (HIV Med 2013;14:182); in China, usually due to TB (Zhonghua Bing Li Xue Za Zhi 2011;40:622)
  • Cystic lymphoid hyperplasia frequently affects parotid gland in HIV+ patients (Histopathology 2013;62:1067, J Cytol 2009;26:146)
  • HIV viremia may drive expansion of T follicular helper cells, which leads to perturbations of B cell differentiation, resulting in dysregulated antibody production (J Clin Invest 2012;122:3271)
  • Chronic lymphadenopathy syndrome: unexplained enlargement of nodes of 2+ extrainguinal sites for 3+ months, in patient at risk for AIDS; historically, without treatment, 25% developed AIDS at followup with weight loss and cachexia
Microscopic (histologic) description
  • Florid reactive hyperplasia (may be serrated, serpentine or dumbbell shaped) containing tingible body macrophages and plasma cells
  • Follicle lysis often present (invagination of mantle lymphocytes into germinal centers, giving them a moth eaten appearance, also called explosive follicular hyperplasia)
  • Monocytoid B cells in sinuses
  • Interfollicular area shows vascular proliferation and abundant plasma cells, granulocytes and macrophages
  • Neutrophils and dermatopathic lymphadenopathy
  • Interfollicular zone shows vascular proliferation, which may progress to Kaposi sarcoma
  • Occasional polykaryocytes
  • Nodes may also show eventual profound lymphocyte depletion and resemble Castleman disease
Microscopic (histologic) images

AFIP images
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HIV associated lymphadenopathy

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HIV lymphadenitis

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p24 staining

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Fas / CD95 staining

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Intraparotid lymph node

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cyst, salivary
gland inclusions
and giant cells

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islands infiltrated
by lymphocytes

Cytology images

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Parotid lymph node:
lymphohistiocytic tangle and
multinucleate giant cell

Positive stains
  • p24 (HIV core protein)
  • CD8 > CD4 lymphocytes (inversion of usual ratio)
Electron microscopy description
  • Prominent follicular dendritic cells
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