I read that one of the early symptoms of HIV is swollen lymph nodes. What particular lymph nodes normally swell? How would you know if a swollen lymph node is a problem?

D.R.

HIV, the human immunodeficiency virus, is the virus that causes AIDS). AIDS itself is an advanced stage of HIV infection characterized by a group of infections, tumors and other disorders. HIV can cause other problems that do not fit the definition of AIDS, one of which is lymph node swelling.

After infection, most people with HIV appear to have no symptoms at all. On examination, however, some of these people have a condition called persistent generalized lymphadenopathy. This is defined as having two or more enlarged lymph nodes that are not next to each other and are not in the inguinal region (groin). This area is excluded because lymph nodes are commonly enlarged there. The lymph node swelling is caused by the rapid multiplication of the virus itself at these sites. Later in the course of the illness, the lymph nodes actually shrink.

I would like to make a few points about the multitude of symptoms that can be seen in HIV. Since HIV disease can involve virtually any organ system, it is not surprising that the manifestations of disease can be so varied. There is no way I, or any doctor, could diagnose HIV based on only a single problem such as enlarged lymph nodes. I take the following approach in my practice. If my patient has significant risk factors for HIV (such as unprotected sex with multiple partners or a history of injecting illegal drugs) and a sign or symptom consistent with HIV that I cannot readily explain with another diagnosis, then I order an HIV test. Since HIV testing (with the proper followup tests) is highly accurate, there really is no harm in getting a test just to be sure.

If you have enlarged lymph glands and you think you are at risk for HIV, get tested. It is that simple. You should have the lymph glands evaluated in any case -- glands that are enlarged for more than a few months should be biopsied (have a sample of tissue removed for examination) to exclude a cancer.