Abdominal lymphadenopathy in HIV remains a challenge due to inaccessibility of lymph nodes and
multitude of causes. The diagnostic yield of EUS FNA in HIV-infected patients with abdominal
lymphadenopathy in the setting of high tuberculosis (TB) prevalence was assessed.
Prospective cohort study was conducted in tertiary referral centres recruiting symptomatic HIV+
patients (N=31, mean age 38.5 years, mean CD4 count 124 cells/μl, WHO stage 3-4 with abdominal lymphadenopathy. EUS was performed to assess lymph node characteristics and FNA aspirate
subjected to cytological analysis, microbial culture and PCR.
EUS appearance of lymph nodes was highly variable. Mycobacterial infections were the most
common cause of lymphadenopathy in this cohort. Of the 31 patients 21/31 67.7 % had
mycobacterial infections; 17 (80.9 %) of these were tuberculosis. Cytology failed to identify 23.8%
and culture 38.1% of cases. PCR identified 16/17 (94.1%) of these cases. EUS-FNA altered the
management of more than half of the patients.
Mycobacterial disease was the commonest cause of lymphadenopathy in HIV but a third of patients
had reactive lymphadenopathy. By combining the appearance of EUS FNA and cytological aspirate
we could develop a diagnostic algorithm with a high PPV and NPV to identify patients in whom
further analysis with PCR would be useful. PCR was highly accurate in confirming mycobacterial
disease and determining genotypic drug resistance.