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The association of lymphadenopathy and HIV infection has been well described, 1 but both the size and distribution of the enlarged lymph nodes have been poorly characterised. In Africa serological testing for HIV infection is both expensive and difficult to obtain, and health care workers often have to rely on clinical features to assess the likelihood of HIV disease. Knowledge of the rate of occurence of enlarged lymph nodes and variations in their size and distribution could help identify useful diagnostic markers. Generalised lymphadenopathy, although suggestive of HIV infection, does not exclude other diagnoses such as viral infections, tuberculosis, and haematological malignancy. Our impression, in a large central hospital in sub-Saharan Africa, was that palpable epitrochlear lymph nodes were a good marker of early HIV disease. Osler noted that such nodes were a prominent clinical feature of secondary syphilis, 2 but nowadays the palpability of this node is not emphasised. 3 4 5 We assessed the value of regional lymph node enlargement, by site and size, as a predictor of HIV disease.
Subjects, methods, and results
All sequential adult patients (>/= 12 years) admitted to an acute general medical ward at this hospital over three months were eligible for the study. Readmissions and patients from specialist clinics were excluded. We obtained informed consent (from parents when appropriate), and all those who entered were given counselling for HIV testing. HIV infection was diagnosed using a double enzyme linked...