Immunohistopathogenesis of persistent generalized lymphadenopathy in HIV-positive patients

Persistent generalized lymphadenopathy (PGL) is a reactive lymphadenitis affecting HIV-positive patients; furthermore, PGL is often a prodrome of AIDS-related complex and AIDS. In the present review the authors describe the histology and the immunohistochemistry of lymph nodes of patients affected by PGL. Histologic alterations of lymph nodes with PGL are classified according to three main types: follicular hyperplasia without or with follicular fragmentation, follicular involution and follicular depletion. Immunohistology demonstrates a peculiar infiltration of CD3+/CD4+ and CD3+/CD8+ lymphocytes in germinal centers; CD3+/CD8+ are often grouped in small clusters centered by a newly formed small blood vessel. Accessory follicular dendritic reticulum cells (FDRCs) of germinal centers are characterized by a positive staining for p24 and p19 HIV major core antigens. In germinal centers, FDRCs undergo progressive lysis in follicular involution and in follicular depletion. Other viral antigens, such as EBV, are infrequently seen in lymph nodes from HIV-positive patients. Paracortical areas of lymph nodes are often characterized by prominent postcapillary venule proliferations and by hyperplasia of the endothelial cells which are HLA-DR positive, often p19 and p24 positive, and occasionally express HIV genome. In conclusion, in PGL the histologic changes correlate well with the immunohistologic features; accordingly, PGL might be considered the result of abnormal immune reactions to several stimuli still incompletely known.