Lymph nodes & spleen, nonlymphoma
Lymph nodes-infectious / parasitic disorders
HIV
Author: Nat Pernick, M.D.
Last author update: 1 August 2013
Last staff update: 20 July 2022
Copyright: 2003-2023, PathologyOutlines.com, Inc.
PubMed Search: HIV [title] lymph nodes [title]
Table of Contents
Definition / general | Clinical features | Microscopic (histologic) description | Microscopic (histologic) images | Cytology images | Positive stains | Electron microscopy description | Additional referencesCite this page: Pernick N. HIV. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/lymphnodeshiv.html. Accessed March 22nd, 2023.
Definition / general
- Acquired immunodeficiency syndrome (AIDS) is principally a disease of lymphoid tissue, because main target of HIV is CD4+ T cell that primarily resides there (Immunol Rev 2013;254:65)
- Besides changes below, HIV+ patients also have mycobacterial infections and associated pseudotumors, Kaposi sarcoma, bacillary angiomatosis, lymphoma and fungal infections
- Dermatopathic lymphadenitis is rare (Indian J Sex Transm Dis 2009;30:103)
- p24 is useful to confirm presence of HIV in lymphoid tissue (Histopathology 2010;56:530)
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
HIV associated lymphadenopathy
Contributed by Nikhil Sangle, M.D.
HIV lymphadenitis
Cytology images
Images hosted on other servers:
lymphohistiocytic tangle and
multinucleate giant cell
Electron microscopy description
- Prominent follicular dendritic cells
Additional references
