HIV and Swollen Lymph Nodes

Lymphadenopathy can occur at any stage of infection and at several sites on the body

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In those with human immunodeficiency virus (HIV), swollen lymph nodes are not only a common occurrence, but one that can occur at any stage of infection. Lymph nodes on the side of the neck, under the jaw, or in the armpits or groin are most often involved.

Any type of infection can cause swollen lymph nodes, also known as lymphadenopathy. But in some cases of HIV, the swelling can be extremely painful and the nodes can get as large as a walnut.

This article describes the cause of swollen lymph nodes in HIV, including when it is more likely to occur. It also explains how lymphadenopathy is treated in people who are infected.

What Is Lymphadenopathy?

Cervical lymphadenopathy

 Coronation Dental Specialty Group / Wikimedia Commons

Lymphadenopathy is not a disease but rather a symptom of a disease.

Lymph nodes are tiny organs distributed throughout the body that support the immune system by filtering bacteria, viruses, and other disease-causing organisms (pathogens) from lymph fluid. The pathogens are then killed by specialized white blood cells known as lymphocytes.

Lymphadenopathy is common when the body is fighting infections like colds, flu, or strep throat. However, it can occur with autoimmune diseases, cancer, and even use of certain medications.

The location of the swollen lymph nodes can tell a lot about the type of disease you have. Lymph node locations include:

  • Axillary lymph nodes (armpits)
  • Cervical lymph nodes (neck)
  • Inguinal lymph nodes (groin)
  • Mediastinal lymph nodes (in the chest cavity)
  • Pelvic lymph nodes (in the pelvis)
  • Retroperitoneal lymph nodes (back of the abdomen)

Lymphadenopathy can also be generalized, meaning that there are swollen lymph nodes throughout the body. This is common with systemic diseases that affect the body as a whole, like HIV.

When Do Lymph Nodes Swell in HIV?

Lymph nodes can swell during the acute or chronic stage of HIV and mean entirely different things based on when the symptom occurs.

Acute HIV Infection

Lymphadenopathy is common during the acute phase of HIV infection—occurring soon after infection when the immune system is actively fighting the virus. The acute phase is also called acute seroconversion or acute retroviral syndrome and affects roughly 70% of newly infected individuals.

Swollen lymph nodes can occur wherever there are lymph nodes in the body—the front or sides of the neck, behind your ears, under your chin, in your armpits, and in the groin area.

Swollen lymph nodes often look like round bumps that can be about the size of a pea or larger, depending on the extent of infection.

Enlarged lymph nodes can be tender and painful. They may also feel rubbery, moveable, and squishy. If there is redness, warmth, or tenderness that may be a sign of inflammation and infection.

Lymphadenopathy in HIV is unique in that the swollen lymph nodes are found throughout the body as opposed to one or two more localized areas which occurs with conditions like the flu, herpes infections, staph infections, or solid tumor cancers.

Widespread lymphadenopathy with nodes larger than 2 centimeters (roughly 1 inch) and lasting for more than three months, is a condition called persistent generalized lymphadenopathy (PGL). 

Advanced HIV Infection

As people enter advanced HIV infection, PGL may resolve, but for some people, it may last for months. When lymph node swelling resolves, it does not mean the virus is inactive; the virus continues to replicate and gradually depletes the immune system.

Taking antiviral medications exactly as prescribed is the only way to slow down or stop the progression of HIV. 

Advanced HIV infection is the second stage of HIV infection and is a chronic phase. It is also called asymptomatic HIV infection or clinical latency. During this stage, HIV continues to multiply in the body but at very low levels.

Opportunistic infections are more common in those with chronic or untreated HIV because the virus depletes the immune system, making it difficult to fight off diseases.

Different opportunistic infections (OIs) may present with lymphadenopathy including:

  • Tuberculosis (TB)
  • Mycobacterium avium complex
  • Toxoplasmosis
  • Disseminated fungal infections
  • Atypical mycobacterial infections
  • Cytomegalovirus infection
  • Malignancy such as non-Hodgkin's lymphoma (NHL)
  • Herpes simplex virus (HSV)
  • Herpes zoster virus (HZV)
  • Invasive cervical cancer (ICC)

Antiretroviral therapy (ART) is commonly used to treat HIV and helps decrease opportunistic infections. By reducing the amount of HIV in the body, the immune system can stay strong and fight off infections better.

It is important to note that some people may develop OIs and PGL despite ART. This is more common in those who:

  • Were not diagnosed with HIV for a long time and therefore have a weakened immune system
  • May not be taking the right combination of medications needed to keep HIV levels low

Immune Reconstitution Inflammatory Syndrome (IRIS)

Immune reconstitution inflammatory syndrome (IRIS) is the worsening of symptoms of previously controlled disease or the unmasking of unsuspected disease after starting ART. Little is known about why IRIS develops but researchers hypothesize that the condition has a paradoxical inflammatory component that results in:

  • Fever
  • Inflammation
  • Lymphadenopathy
  • Opportunistic Infections

IRIS often resolves on its own. Taking corticosteroids like prednisone for one to two weeks may lead to a quicker resolution of IRIS symptoms.

Are My Swollen Lymph Nodes Due to HIV?

Symptoms of Acute HIV Infection

Verywell / Colleen Tighe

During acute HIV infection, swollen lymph nodes most often occur in two or more sites in the body. The cervical lymph nodes are commonly affected as well as the axillary and inguinal lymph nodes.

In this stage, lymphadenopathy is self-limiting and will usually resolve on its own within weeks or months. The swelling may be mild and relatively painless.

With that said, some people may experience visible, unsightly swelling with severe pain.

In addition to the swelling, lymphadenopathy may be accompanied by other symptoms during the acute phase, including:

  • Fever
  • Fatigue
  • Tiredness
  • Muscle or joint pain
  • Sore throat
  • Headache
  • Diarrhea
  • Rash

Lymphadenopathy and accompanying symptoms of acute HIV infection can last anywhere from a few days to several weeks. Not everyone newly infected with HIV develops lymphadenopathy or realizes that they have it. It is not uncommon for people to think they have a cold or flu and miss the early signs of HIV infection.

For some people, lymphadenopathy doesn't occur until HIV is advanced and the immune system is fully compromised. This is when opportunistic infections (OIs) like tuberculosis or toxoplasmosis can develop. In such cases, lymphadenopathy is the result of the OI rather than HIV itself.

Other Causes of Swollen Lymph Nodes

A range of infections other than HIV can also cause swollen lymph nodes, such as:

  • Measles
  • Tonsilitis
  • Ear infections
  • Tooth infections
  • Colds, flu, and other infections
  • Gingivitis (inflammation of gums)
  • Mononucleosis
  • Mouth sores
  • Sexually transmitted illness (STI)
  • Tuberculosis
  • Skin infections
  • Leukemia
  • Hodgkin disease
  • Non-Hodgkin's lymphoma

Although lymphadenopathy can occur for any number of reasons, PGL is a stronger indication that HIV is involved.

Diagnosis

Contact your health care provider if:

  • Your lymph nodes do not get smaller after several weeks or continue to get larger.
  • Lymph nodes are red and tender.
  • Lymph nodes feel hard, irregular, or fixed in place.
  • You have a fever, night sweats, or unexplained weight loss.

Your healthcare provider will take a medical history and may ask if you are experiencing any associated symptoms, such as:

  • Fever
  • Weight loss
  • Muscle and joint aches
  • Fatigue
  • Headache

They may also ask about:

  • Previous sexual partners
  • Intravenous drug use
  • Other viral infections or sexually transmitted diseases
  • Recent blood transfusions
  • Occupational exposure to blood, like accidentally being stuck by needles

The physical exam will consist of:

  • Checking the lymph nodes
  • Examining the skin for rashes
  • Looking in the mouth for signs of candidiasis (white patches that signal infection with an opportunistic fungus)  

A biopsy of the lymph node may also be taken, called fine-needle aspiration cytology (FNAC), to identify the type of virus.

As a rule of thumb, you should get tested for HIV if the following occurs:

  • Your lymph glands remain swollen for more than two to four weeks.
  • The swelling persists even after other signs of illness have cleared.
  • You are sexually active or an injecting drug user.

The U.S. Preventive Services Task Force recommends that all people ages 15 to 65 who reside in the United States be tested for HIV as part of a routine medical visit, whether they experience swollen glands or not.

Treating Swollen Lymph Nodes

If left untreated, HIV lymphadenopathy can resolve on its own within weeks or months. With that said, HIV should never be never left untreated.

In the end, the one surefire way to resolve swollen lymph nodes due to HIV is to start antiretroviral therapy. This is the daily use of two or more drugs able to bring the virus under control.

Antiretroviral drugs don't "cure" HIV but suppress the virus to levels where it can do little harm to the body. By reducing the viral burden in the body, also known as the viral load, your lymph nodes will no longer be overtaxed and can return to their normal size.

Antiretroviral therapy can also extend life expectancy to near-normal levels and dramatically reduce the risk of HIV-associated and non-HIV-associated diseases. Moreover, if the viral load remains undetectable, your odds of infecting someone else are reduced to zero.

Until lymphadenopathy symptoms are fully resolved, an over-the-counter nonsteroidal anti-inflammatory drug (NSAID) like Advil (ibuprofen) or Aleve (naproxen) can provide short-term pain relief.

Summary

Swollen lymph nodes are common in many different medical conditions, including HIV. Lymphadenopathy associated with HIV tends to occur in more than one part of the body, such as the neck, groin, and armpits.

Lymphadenopathy can occur at any stage of HIV. Contact your healthcare provider if you have had swollen lymph nodes for several weeks or if you are experiencing any associated symptoms.

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Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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By James Myhre & Dennis Sifris, MD
Dennis Sifris, MD, is an HIV specialist and Medical Director of LifeSense Disease Management. James Myhre is an American journalist and HIV educator.