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  • Title: Importance of human immunodeficiency virus-associated lymphadenopathy and tuberculous lymphadenitis in patients undergoing lymph node biopsy in Zambia.
    Author: Bem C, Patil PS, Bharucha H, Namaambo K, Luo N.
    Journal: Br J Surg; 1996 Jan; 83(1):75-8. PubMed ID: 8653372.
    Abstract:
    The relative importance of human immunodeficiency virus (HIV)-associated lymphadenopathy amongst patients presenting for lymph node biopsy in Central Africa is unknown. HIV-1 serology and histology of patients undergoing superficial lymph node biopsy during 1989-1990 in Lusaka, Zambia, were examined in a prospective cohort study of HIV serology and by retrospective review of laboratory records. Of 727 lymph nodes biopsied in Lusaka in 1989-1990, 380 (52 per cent) showed tuberculous lymphadenitis, 160 (22 per cent) histology suggestive of primary HIV lymphadenopathy and 66 (9 per cent) nodal Kaposi's disease. HIV serology was tested in 280 adults and was positive in 91 per cent (255 patients), including 89 per cent (153 of 171) of those with tuberculous lymphadenitis, 98 per cent (63 of 64) of those with histology suspicious of primary HIV lymphadenopathy and all (24 of 24) with nodal Kaposi's disease. Other HIV-associated lymphadenopathy included nodal lymphomas and lymphoepithelial cysts. HIV serology was tested in 22 children and was positive in eight, including four of 14 with tuberculous lymphadenitis. It is concluded that HIV-associated lymphadenopathy, especially tuberculous lymphadenitis, is very common amongst patients presenting for lymph node biopsy in Central Africa. Data from a prospective cohort study conducted during 1989-1990 of HIV serology and from a retrospective review of laboratory records of 727 patients presenting for superficial lymph node biopsy at the University Teaching Hospital in Lusaka, Zambia, were analyzed to determine the relative significance of HIV-associated lymphadenopathy among patients undergoing lymph node biopsy. 380 (52%) of the 727 biopsy patients had tuberculous lymphadenitis (secondary HIV lymphadenopathy). Another 160 (22%) had presumed primary HIV lymphadenopathy. The remaining 66 (9%) had nodal Kaposi's disease. 280 adults were tested for HIV antibodies. 91% tested positive for HIV. The HIV rate was 89% for patients with tuberculous lymphadenitis, 98% for suspected primary HIV lymphadenopathy cases, and 100% for those with nodal Kaposi's disease. As for the 22 children 0-16 years old, 8 were HIV positive. 50% of HIV-positive children who underwent lymph node biopsy had tuberculous lymphadenitis. Three had suspected primary HIV lymphadenopathy and 1 had nodal Kaposi's disease. These findings show that HIV-associated lymphadenopathy, particularly tuberculous lymphadenitis, is very prevalent in patients undergoing lymph node biopsy. They stress the importance of investigating further HIV-positive patients with suspicious asymmetrical nodes in central Africa. Simple, appropriate methods (e.g., wide-needle aspiration) are needed for the diagnosis of tuberculous lymphadenitis in this region, with its dearth of facilities for surgery and histopathology.
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