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Cytomorphological Analysis of Lymph Node Lesions in HIV-Positive Patients with CD4 Count Correlation: A
Sadia Siddiqa Nasser1, Rashmi K Patil, Shreekanth K Kittur
1Department of Pathology, Belagavi Institute of Medical Sciences, Belagavi, India.
Insights
Fine-needle aspiration cytology (FNAC) effectively identifies lymph node lesions in HIV-positive patients. Cytological findings strongly correlate with CD4 counts, aiding in immune status assessment and disease management.
Area of Science:
- Medical Diagnostics
- Immunology
- Infectious Diseases
Background:
- Human Immunodeficiency Virus (HIV) infection significantly impacts the immune system, leading to opportunistic infections and neoplastic conditions.
- Lymphadenopathy is a common clinical manifestation in HIV-positive individuals, requiring accurate etiological diagnosis.
- Assessing immune status through CD4 counts is crucial for staging HIV disease and guiding treatment.
Purpose of the Study:
- To delineate the spectrum of cytomorphological changes in lymph node lesions among HIV-positive patients.
- To establish the correlation between cytological findings of lymph node lesions and CD4+ T-cell counts.
- To evaluate the utility of Fine-Needle Aspiration Cytology (FNAC) in diagnosing lymph node pathologies in this population.
Main Methods:
- A cross-sectional study involving 110 HIV-positive patients was conducted over 23 months.
- Fine-Needle Aspiration Cytology (FNAC) was performed on palpable lymph nodes, with special stains and cultures used as needed.
- CD4 counts were determined by flow cytometry and correlated with cytological diagnoses.
Main Results:
- The predominant lesion was tubercular lymphadenitis (53.6%), followed by reactive lymphadenitis (27.1%).
- Significant correlations were observed between specific cytological findings and CD4 counts (χ² = 44.57, p < 0.001).
- Lesions included lymphoma (4.5%), cystic lymphoid hyperplasia (2.8%), and metastases (1.9%), among others.
Conclusions:
- FNAC is a safe and valuable tool for diagnosing lymph node lesions, including opportunistic infections and neoplasms, in HIV-positive individuals.
- Correlating cytological findings with CD4 counts provides critical insights into immune status and HIV disease stage.
- This integrated approach aids in patient management and therapeutic decision-making.
Objectives:
To study the cytomorphological spectrum of lymph node lesions in HIV-positive patients and correlate the cytological findings with the CD4 count.
Study Design:
This was a cross-sectional study of 23 months' duration which included 110 HIV-positive cases proved according to the guidelines of the National AIDS Control Organisation. Fine-needle aspiration cytology (FNAC) was done on clinically palpable lymph nodes. Special stains and culture were done wherever necessary. CD4 count was done by flow cytometry and subsequently correlated with the cytological findings.
Results:
Our study included 110 cases, ranging in age from 6 to 70 years, peaking in the 3rd to 4th decade (n = 46). The male-to-female ratio was 1.75:1 and the predominant site was the cervical group of lymph nodes (n = 71). Each lesion was correlated with CD4 count, laboratory and clinical findings, and was further segregated based on WHO and CDC staging. Cytological lesions were tubercular (53.6%), reactive (27.1%), suppurative (6.4%) lymphadenitis, lymphoma (4.5%), cystic lymphoid hyperplasia (2.8%), metastases (1.9%), cryptococcal lymphadenitis (0.9%). The mean CD4 count was 217.4, 434.4, 181.4, 149, 580, 225, and 207 cells/µL, respectively. There was a highly significant correlation of cytological findings with CD4 count (χ2 value = 44.57 and p < 0.001).
Conclusion:
FNAC is a primary, safe, and valuable tool for the identification of opportunistic infections, neoplastic and nonneoplastic lesions, as well as therapeutic modality in certain conditions. Correlation of lesions with CD4 count provides information about immune status, HIV stage and segregating cases, and also aids further evaluation and management.
