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Distribution characteristics of lymph node biopsy pathology across different CD4⁺ T-lymphocyte strata in HIV-infected patients and their clinical implications: a retrospective cross-sectional study
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DOI：10.1186/s40001-026-05036-x.png)
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Abstract
En 中文
Lymphadenopathy is a frequent manifestation in people living with HIV (PLWH), yet its pathological etiologies vary widely with the degree of immunosuppression. Systematic stratification of lymph node biopsy pathology across the full continuum of CD4⁺ T-lymphocyte counts in the contemporary antiretroviral therapy (ART) era remains incompletely characterized. A retrospective cross-sectional study analyzed 300 HIV-infected patients who underwent excisional or core needle lymph node biopsy between January 2022 and December 2025. Histopathological diagnoses, classified into reactive lymphadenitis, opportunistic infections, lymphoproliferative neoplasms, Kaposi sarcoma, metastatic carcinoma, and other entities, were stratified by CD4⁺ counts (> 500, 200–500, 50–199, and < 50 cells/μL). Special stains, immunohistochemistry, EBER in situ hybridization, and mycobacterial PCR were performed as indicated. Multivariate logistic regression identified independent predictors of opportunistic infection and lymphoproliferative neoplasm. The pathological spectrum demonstrated a stepwise shift with declining CD4⁺ counts. Opportunistic infections were the most common diagnostic category overall (44.0%), with Mycobacterium tuberculosis lymphadenitis representing the single most frequent diagnosis (29.3%). Reactive follicular hyperplasia predominated in the > 500 cells/μL stratum (43.9%), while mycobacterial granulomas, Talaromyces marneffei lymphadenitis, and aggressive lymphomas including plasmablastic lymphoma and EBV-positive diffuse large B-cell lymphoma were preferentially enriched in patients with CD4⁺ < 200 cells/μL. CD4⁺ < 50 cells/μL was an independent predictor of opportunistic infection (adjusted OR 4.62; 95% CI 2.31–9.24), whereas CD4⁺ 50–199 cells/μL was most strongly associated with lymphoproliferative neoplasms (adjusted OR 3.18; 95% CI 1.54–6.57). The pathological spectrum of HIV-associated lymphadenopathy exhibits distinct CD4⁺-dependent distribution patterns, providing a clinically actionable framework for prioritizing differential diagnoses and guiding ancillary testing in PLWH.
Keywords:
HIV
Lymph node biopsy
Histopathology
CD4⁺ T lymphocyte
Opportunistic infection
Lymphoproliferative neoplasm
Antiretroviral therapy
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