Clinical predictors for the aetiology of peripheral lymphadenopathy in HIV-infected adults.
OBJECTIVE
The aim of the study was to determine the aetiology and clinical predictors of peripheral lymphadenopathy in HIV-infected individuals during the antiretroviral (ARV) era in a nontuberculosis endemic setting.


METHODS
A multicentred, retrospective cohort study of peripheral lymph node biopsies in HIV-positive adults was carried out. A total of 107 charts were identified and reviewed for clinical features, lymphadenopathy size, and ARV use and duration. Biopsy results were categorized, and multivariate logistic regression determined independent predictors of lymphadenopathy aetiology.


RESULTS
Evaluation of 107 peripheral lymph node biopsies revealed that 42.9% of peripheral lymphadenopathy was attributable to malignancy, 49.5% to reactive changes, and 7.5% to infections, with only 2.8% of all cases secondary to tuberculosis. Fevers, weight loss, ARV use, and lower viral loads are significantly associated with nonreactive lymphadenopathy.


CONCLUSIONS
Lymphadenopathy is likely to be reactive or malignant in nontuberculosis endemic regions. Readily available clinical features can aid clinicians in predicting the underlying aetiology, those at risk for malignancy, and who to biopsy.
Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA 02114, USA. ibogoch@partners.org
I I
II
Bogoch
J R
JR
Andrews
E H
EH
Nagami
A M
AM
Rivera
R T
RT
Gandhi
D
D
Stone
D000386:AIDS-Related Complex / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology; D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology; D000163:Acquired Immunodeficiency Syndrome / Q000150:complications* / Q000453:epidemiology / Q000473:pathology; D000328:Adult; D001706:Biopsy; D001900:Boston / Q000453:epidemiology; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D005260:Female; D006679:HIV Seropositivity / Q000150:complications* / Q000453:epidemiology / Q000473:pathology; D006801:Humans; D016015:Logistic Models; D008198:Lymph Nodes / Q000473:pathology*; D008206:Lymphatic Diseases / Q000209:etiology* / Q000473:pathology; D008228:Lymphoma, Non-Hodgkin / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015270:Mycobacterium avium-intracellulare Infection / Q000453:epidemiology; D012189:Retrospective Studies; D012514:Sarcoma, Kaposi / Q000453:epidemiology; D013587:Syphilis / Q000453:epidemiology; D014388:Tuberculosis, Lymph Node / Q000453:epidemiology; D019562:Viral Load