Lymphadenopathy in HIV infected adults at Kenyatta National Hospital

Abstract

Objective: To determine the aetiology of lymphadenopathy in HIV/AIDS patients at Kenyatta National Hospital. ** Design: Cross sectional descriptive study with aonsecutive sampling. ** Setting: Medical out-patient clinics and the medical wards at Kenyatta National Hospital, between May 1993 and April 1994 Period. ** Methods: Consecutive patients with significant palpable lymphadenopathy who were HIV positive aware of their status and consented were evaluated. Clinical evaluation was done especially for evidence of fever, aneamia, Jaundice, wasting and oral thrush. Total blood count and CD4/CD8 counts were done on each patient. An accessible lymph node was identified and excision biopsy done under local anaesthesia. The lymph node specimen was sent for histologic examination. Outcome Measures: Lymph node histology, CD4 counts, and haematological parameters (Haemoglobin, total white cell count and platelets). ** Results: One hundred patients satisfied the inclusion criteria but only 71 had lymph node biopsy done. Forty (40%) males and 31 (31%) females were included, with age range of 16-67 uears. The population mean age was 33.6 12.7 years. The male female ration was 1.3:1. The cervical region was the commonest site of lymphadenopathy, found in 83.1% of the cases. Tuberculous adenitis occurred in 80.3% of the cases and was the commonest cause of lymphadenopathy. Other causes included, reactive adenitis (11.03%), Kaposi's sarcoma4.2%,High grade Lymphoma 2.8% and polyarteritis nodosa 1.4%. Compared to malignant causes, TB adenitis occurred at a seemingly low CD4 cell count of 141 186 Imlcompared to patients with High grade Lymphoma 35017/ml. Conclusion: Tuberculosis adenitis is the main .cause of lymphadenopathy in HIV IAIDS patients with significantly enlarged lymph nodes at Kenyatta National Hospital. TB adenitis also occurs at a fairly low CD4 count in this population consistent with AIDS defining illness. Malignant causes of lymphadenopathy were found to be rare in patients in this study.