[Question #2522] Abnormal Lymph Node Biopsy

45 months ago
Hi Doctors,

I just had a biopsy done from a swollen lymph node that's been there for 4+ months in my neck. I had other swollen nodes in my neck but they took just the largest one. Pathologists suspected lymphoma and had to send for further testing (hemotologist). There, it was ruled non-cancerous. They did say that the node was very abnormal. 
Ive read that abnormal nodes could be aligned to HIV.  

My tests: 
5 week 4th gen at LabCorp. (-)
6 month 4th gen at LabCorp. (-)

Q1)  I've read that lymph nodes could swell up within the year of being affected. I'm talking post seroconversion/ARS.  I've also read that abnormal findings in nodes can be suggestive of HIV as well. Do I have cause for worry? 

Q2) Im a female and take biotin daily for my hair and nail growth. I've read that biotin can affect hiv testing. LabCorp and other lab websites even disclose to not take biotin 3 days before tests ...In what way can they affect 4th gen test? False positives or false negatives?

Q3) I had a CBC Blood panel done a few days ago. 
White Blood Count read 7.2
Red Blood Count read 3.64. 
I am now almost 10 months from my exposure.  Would my counts read differently if  I had HIV and wasn't on medication? 

During my follow up with my ENT, he said no cancer but asked further questions to troubleshoot the reason for my abnormal node. He even asked about a STD test panel because my lymph node biopsy was highly abnormal. This is what caused me to come back here and this situation has "re-opened" this all over again for me. Just when I started to leave this behind me, I was sucked right back in....and that really.....well....sucks. 

Can you please shed some light on these topics for me. Thanks! 


H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
45 months ago
Welcome back to the forum.

Sorry to hear you needed the biopsy. However, for sure the problem isn't HIV. The HIV tests are among the most accurate diagnostic tests ever developed, for any medical condition. The results always overrule symptoms, exposures history, or anything else. There are numerous causes of enlarged or inflamed lymph nodes, and your negative HIV tests prove HIV isn't the cause in your case. If you haven't been tested for syphilis, that would make sense:  aside from HIV, that's the only STD that might cause this sort of enlarged or inflamed lymph nodes. 

1) Speak with your doctor about the "abnormal changes" in your lymph nodes. My guess is the report may refer to "reactive" changes in the node, which can be caused by many infections and other problems other than HIV. Indeed, HIV is one of the rarest causes of such problems. Further, the changes associated with HIV usually can be pretty easily diagnosed by the pathologist. Even if not in this case, your blood tests prove HIV isn't the cause. See my closing comments below.

2) You're spending too much time online!  There are NO medications that alter the reliability of HIV testing, and for sure biotin cannot do so.

3) Your CBC is pretty normal, and in any case irrelevant. No matter how normal or abnormal, blood counts generally give no clues about HIV.

The large majority of otherwise unexplained lymph node inflammation (reactive lymphadenitis) are not HIV or any STD. Talk to your doctor about cat scratch disease (especially if you have contact with cats), tuberculosis, other TB-like infections, fungal infections, and more. Your travel and exposure history may be relevant. If the cause remains obscure, ask for referral to an infectious diseases specialist. But in the meantime, you can be 100% confident that HIV isn't the problem.

I hope this information is helpful. Let me know if anything isn't clear.

HHH, MD


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45 months ago
Thanks for the speedy reply, Dr H. 
....And for the good news! :)

You mentioned that the pathologist can usually spot and diagnose hiv after looking at the lymph node.  Would they have to report that back as a finding if that were the case? To my doctor or in my biopsy report? 

I've tested for HIV twice but have not tested for and other STIs. When I go to my doctor, what kind of lingo do I use to ask him to test for syphillis, HPV, etc...I want a panel that will cover all the STIs...Is it just called a n STI work-up? 

Thanks again! 


H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
45 months ago
I should clarify my comment about HIV and lymph node biopsy. It can give clues, but not necessarily a conclusive diagnosis of HIV. If the biopsy had suggested HIV, probably it would have been in the report. But even if that were found, the blood test is more reliable. That is the main evidence you don't have HIV and those results are conclusive.

In your other thread, I recommended syphilis testing, because syphilis can cause lymph node inflammation. It is very unlikely for localized problem you have; as for HIV, lymph node enlargements with syphils generally are widespread and you would have the problem in several body locations. But a blood test is simple, and better safe than sorry. Other routine STD testing in women includes vaginal swabs for gonorrhea, chlamydia, and a DNA test for trichomonas, and evaluation for vaginal infections including bacterial vaginosis and yeast. Other than these, just tell your doctor your concerns and follow her advice. In selected cases, blood tests would be recommended for hepatitis B and herpes, but this would be based more on your past sexual history and symptoms rather than any single encounter.

As I said last time, it remains very unlikely that your lymph node problem is in any way related to your sexual exposure 7-8 months ago.
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45 months ago
Thanks Dr. 
Last Q, then I understand that you have to close this thread. 
I've started seeing someone. The other night, we had a few beers at a bar and I asked him to get tested for my peace of mind. Obviously, I don't need anymore anxiety or stress over hiv. 
After a few beers, we drove across the street and we bought oraquick kit. We went into the car and read directions and he took the test. He said he was last with another woman about 6 weeks or so ago. It was negative. I'd say that it was about 15 minutes from the time we finished our beers until the time he swabbed his gums. Are you able to tell me if the alcohol we had makes the test useless? 

Also, we swabbed both sides of the stick and I think we did it right. Do these tests have to be done absolutely perfect or do you think the company expects some roommfor error? 

Thanks for all you do Dr. You are helping many people. I'm
Very appreciative of you. :) 


H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
45 months ago
Heterosexually transmited HIV is much less common than you apparently fear, and the chance any particular straight guy has HIV is very low. Second, the oral swab home self HIV test is pretty much foolproof if the instructions are followed -- and as you rightly suspect, of course the manufacturer took into account that not everyone would follow the instructions carefully, and also considered all the things that might be common in tested people:  various medications, alcohol, other health problems, etc. These make no difference in test reliability. That said, the home self test is the one HIV test that takes up to 3 months for conclusive results. Still, the chance this new partner has HIV is very low.

Unless there is an amazing coincidence, you are the same person in a different thread about herpes. (You posted a follow-up comment there that apparently was intended for me in this thread.) Please note that the forum requires users to maintain a single username and account. You'll be getting a heads-up from the web administrator about it.

But I do hope this discussion, and your other thread with me and the one with Terri, have all been helpful. But please don't get in the habit of coming here everytime you have a new concern along these lines. Repetative questions are discouraged.
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45 months ago
Hi Dr. H, 
I actually wrote my last question to you and i thought it didn't send so I had to rewrite it again. I didn't mean to write Pat. I didn't even know it was sent out. My fault! Thanks for all your help. 
Even tough the oraquick is not 100% until 3 months, would you say it's around 90% at six weeks or so? 

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
45 months ago
Yes, probably about 90-95% at 6 weeks.

That concludes this thread. Take care.

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