Lymph node enlargement in patients with unsuspected human immunodeficiency virus infections

The histologic findings in lymph nodes were used to identify eight patients, who are not in a high-risk group, with human immunodeficiency virus (HIV) infection. In order to determine the specificity of these findings, the histologic and clinical findings in these patients were compared with the histologic and clinical findings in 40 patients whose lymph nodes exhibited reactive follicular hyperplasia and who received biopsies before 1981. While a definitive diagnosis of HIV infection cannot be made from the histologic changes in lymph nodes because the organisms cannot be identified, our findings indicate that HIV infection can be suggested, and appropriate testing warranted, when marked reactive follicular hyperplasia with mononuclear cells (and a small number of neutrophils) in parafollicular sinuses is found in a patient with unexplained lymph node enlargement at two or more noncontiguous, noninguinal sites for several months, with or without systemic symptoms.