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 ~  Abstract
 ~  Materials and Me...
 ~  Results
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Year : 2002  |  Volume : 20  |  Issue : 2  |  Page : 99-101
 

People living with HIV infection / AIDS - A study on lymph node FNAC and CD4 count


Dept. of Tropical Medicine, School of Tropical Medicine, Kolkata, India

Correspondence Address:
Dept. of Tropical Medicine, School of Tropical Medicine, Kolkata, India

 ~ Abstract 

Between July 1997 and December 2000, 1616 HIV seropositive persons were identified by Western Blot test at the School of Tropical Medicine, Kolkata. Four hundred seventy two (29.2%) of them had generalized lymphadenopathy. CD4 count could be done in only 54 of these 472 subjects (11.4%). These 54 patients, consisting of 40 males (74%) and 14 females (26%) were the subjects of the study. Their mean age was 29.5 years. In all these subjects, FNAC was done from the enlarged lymph nodes (non-inguinal). Reactive hyperplasia was seen in 30 cases (55.5%) whose absolute CD4 count varied between 411-945 cells/無 (median value 670 cells/無). Evidence of tuberculous lymphadenitis was detected in 22 (41%) with CD4 counts varying between 113 and 422 cells/無 (median value 212 cells/無). Non-Hodgkin lymphoma was diagnosed in 2 cases (3.7%) with CD4 count 79-113 cells/無. All patients had evidence of HIV-1 infection, excepting one case of dual infection (HIV-1 and 2).

How to cite this article:
Shobhana A, Guha S K, Mitra K, Dasgupta A, Neogi D K, Hazra S C. People living with HIV infection / AIDS - A study on lymph node FNAC and CD4 count. Indian J Med Microbiol 2002;20:99-101


How to cite this URL:
Shobhana A, Guha S K, Mitra K, Dasgupta A, Neogi D K, Hazra S C. People living with HIV infection / AIDS - A study on lymph node FNAC and CD4 count. Indian J Med Microbiol [serial online] 2002 [cited 2014 Apr 24];20:99-101. Available from: http://www.ijmm.org/text.asp?2002/20/2/99/8359


The Human Immunodeficiency Virus (HIV) infection leading to AIDS is now considered to be one of the major public health problems. South East Asia has become the epicenter of HIV/AIDS pandemic and it has been predicted that majority of the new infections will occur in South East Asia.[1] The present HIV scenario in Asia is also alarming and there are nearly 5 million people living with HIV in India.[2]
Lymphadenopathy is a very common manifestation of HIV infection. Although extensive studies on HIV/AIDS patients have been done in the Western countries to know the causes of lymphadenopathy,[3],[4],[5] there is pressing need for further studies in this field in our country. Therefore, this study was undertaken to observe the incidence of lymph node involvement with HIV infection, to find out the pathological changes in the lymph nodes by FNAC and to establish a correlation with FNAC findings and the CD4 count.

 ~ Materials and Methods Top

Between July 1997 and December 2000, 1616 HIV seropositive persons were detected by ELISA test and confirmed by Western Blot test (INNO-LIA HIV-1/HIV2 Ab, INNOGENETICS N.V.BELGIUM) in the Department of Virology, School of Tropical Medicine, Kolkata and Medical College, Kolkata.
Out of 1616 HIV seropositive persons, 472 had generalized lymphadenoapthy. Absolute CD4 count be done in only 54 subjects. These 54 persons with available CD4 count were the subjects in this study. There were 40 males (74%) and 14 females (26%) with a mean age of 29.5 years. All the 40 males had history of multiple sexual exposure. Out of the 14 females, 12 were wives of HIV/AIDS patients and the remaining two were commercial sex workers. Age and sex wise distribution of study subjects has been shown in [Table - 1].
FNAC was done from the largest non-inguinal lymph node in all these 54 subjects. The FNAC material was stained with Haematoxylin and Eosin, Leishman-Giemsa and Ziehl-Neelsen stain for studying cytological changes and detection of acid fast bacilli. Only in 2 cases of Non-Hodgkin lymphoma biopsy was done for confirmation. Examination of sputum for AFB and X-ray chest were done for confirmation. CD4 count was done by Flow cytometer.

 ~ Results Top

FNAC revealed evidence of reactive hyperplasia in 30 cases (55.5%) where CD4 count varied between 411 - 945 cells/無), (medium value was 670 cells/無) evidence of tuberculous lymphadenitis was detected in 22 subjects (41%) with their CD4 count varying between 113-422 cells / 無 (median value 212 cells/無). NHL was diagnosed in 2 cases (3.7%) with CD4 count 79 and 113 cells/無. All the patients had evidence of HIV 1 infection expecting one case showing reactive hyperplasia who had both HIV1 and 2 infection. Correlation of CD4 range and cytological diagnosis is shown in [Table - 2].
In 30 cases whole range of lymphocytes predominantly mature lymphocytes, histiocytes, tingible body macrophages were found and diagnosed as cases of reactive hyperplasia. Extensive caseation with scanty epithelioid cell granuloma was seen in 22 cases which were diagnosed as tuberculous lymphadenitis.
Z-N staining of FNAC material however revealed presence of AFB in 8 out of 22 subjects. In these 22 patients X ray chest showed evidence of hilar lymphadenopathy in 10 cases, parenchymal lung involvement in 6 cases, both hilar and parenchymal involvement was seen in 4 cases. Sputum was positive for AFB in four cases only.

 ~ Discussion Top

Lymphadenopathy in HIV infection is very common. Apart from the other causes of lymphadenopathy, HIV infection itself may produce persistent generalised lymphadenopathy (PGL). HIV is a lymphotrophic virus and the kinetics of HIV replication are rapid in stable asyptomatic infection with considerable variation in magnitude of replication.[6] Various opportunistic infections and malignancies may be responsible for the enlargement of lymph node in HIV/AIDS.
The present study revealed only 3 types of pathology in lymhadenopathy cases by FNAC. Out of 54 subjects with lymphadenopathy, FNAC showed features of reactive hyperplasia in 30 cases (55.5%), evidence of tuberculous lymphadenitis and NHL was found in 22(41%) and 2(3.7%) cases respectively. The study also revealed the correlation between absolute CD4 and the FNAC findings. The median value of CD4 count was 672 and 212 cells/無 in case of reactive hyperplasia and TB lymphadenitis respectively. It is generally considered that the CD4 count decrease is much more evident in lymphoma where the count may fall below 100 cells/無[7] and observation of the present study corroborates well with the description.
Lakshmi et al[8] documented 186 cases of tubercular infection out of 643 HIV reactive cases, of which 26(14%) had TB lymphadenitis proven by FNAC and ZN stain. Overall tuberculous infection was observed by Sircar et al in 54.88% cases.[9] Evidence of active tuberculosis was seen by Kaur et al as high as 68-85% of AIDS patients.[10]
Extra pulmonary tuberculosis especially involving cervical group of lymph nodes was the commonest presentation as observed by Arora et al[11] who had also opined for FNAC or biospy of lymph nodes, as an immediate diagnostic tool in HIV/AIDS. Grant HW studied biospy specimen of 14 children with PGL. He observed reactive hyperplasia in 11 cases and tuberculous lymphadenopathy in 3 cases.[12]
In the present study, CD4 count was very low in 2 cases of NHL (113 and 79 cells/無). Though the number of study subjects is not very high, we may conclude that apart from reactive hyperplaisa, tuberculosis of lymph node is likely to be very common in our country with CD4 count around 100-400 cells/無.
There is no doubt that biopsy is a better diagnostic tool, but FNAC can serve as an alternative method and may be practiced for diagnosis of opportunistic infections in HIV/AIDS viz. tuberculosis, histoplasmosis, toxoplasmosis and malignant conditions like Kaposi's sarcoma and lymphomas etc. Apart from cytological examination, culture of the aspirated material in appropriate media may increase the diagnostic efficacy. 

 ~ References Top

1.Merrtens TE, Low Beer D. HIV and AIDS. Where is the epidemic going? Bulletin of the World Health Organization 1996; 74:12-19.  Back to cited text no. 1    
2.Chakraborty MS, Chakraborty A. Tuberculosis and HIV illness. J Indian Med Assoc 2002; 98:103-106.  Back to cited text no. 2    
3.Jeena PM, Coovadia HM, Hadley LG, et al. Lymph node biopsies in HIV - infected non -infected children with persistent lung disease. International Journal of Tuberculosis and Lung Diseases 2000; 4:139-146.  Back to cited text no. 3    
4.Bhoopat L, Patanasakpinyo C, Yanaranop M, Bhoopat T, et al. Clinicoimmunopathological alterations of lymphonodes from Human Immunodeficiency Virus-infected patients in Northern Thailand. Asia pacific Journal of Allergy & Immunology 1999; 17:85-92.  Back to cited text no. 4    
5.Lambertucci Jr, Rayes AA, Nunes F, Palacis JE, Norbe V, et al. Fever of undetermined origin in patients with the acquired immunodeficiency syndrome in Brazil: report on 55 cases. Regist do Institute de Medicina Tropical Desao Paulo 1999; 41:27-32.  Back to cited text no. 5    
6.Stillbrink HJ, Van Lunzen J, Hufert FT, et al. Asymptomatic HIV infection is characterized by rapid turnover of HIV RNA in plasma and lymph node but not of latently infected lymph node CD4 + Tcells. AIDS 1997; 11:1103-1110.  Back to cited text no. 6    
7.Faui AS, et al. HIV disease; AIDS and related disorders. Harrison's Principles of Internal Medicine, Mc Graw Hill, 14th Edn, 1998; PP 1838-1839.  Back to cited text no. 7    
8.Lakshmi V, Teja VD, Sudha Rani T, Subhada K, Upadhay AC, Shantaram V. Human Immunodeficiency Virus Infection in a Tertiary Care Hospital - Clinical and Microbiological Profile. JAPI 1998; 46:363-367.  Back to cited text no. 8    
9.Sircar AR, Tripathi AK, Choudary SK, Misra R: Clinical profile of AIDS; a study at a referral Hospital. JAPI 1998; 46:775-778.  Back to cited text no. 9    
10.Kaur A, Babu TG, Jacob M, et al. Clinical and laboratory profile of AIDS in India. J Acquir Immuno Defic Synd 1992; 5:883-889.  Back to cited text no. 10    
11.Arora VK, Kumar SV. Pattern of opportunistic pulmonary infections in HIV seropositive subjects: Observations from Pondicherry. Indian Journal of Chest Diseases & Allied Sciences 1999; 41:135-144.  Back to cited text no. 11    
12.Grant HW. Patterns of presentation of Human Immunodeficiecy Virus type 1-infected children to the paediatric surgeon. Journal of Paediatric surgery 1999; 34:251-254.   Back to cited text no. 12    
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