Skin disorders common among people with HIV despite modern treatments, study finds

Human fungal infection (Dermatophytosis/Mycosis) on the forearm. Photo by Asurnipal via Wikimedia Commons

Nearly half of people living with HIV continue to experience skin conditions, despite major advances in antiretroviral therapy, according to new research led by investigators at George Washington University.

The study, published through the DC Cohort—a major longitudinal project tracking HIV outcomes in the Washington, D.C. area—reviewed medical records from 11,738 adults between 2011 and 2023. Researchers found that 49% of participants had at least one dermatologic diagnosis, most often infectious conditions such as fungal infections, herpes, and viral warts.

“Dermatologic disease has always been a hallmark of HIV, and while treatment has dramatically reduced many risks, skin conditions remain a significant burden,” said Dr. Adam Friedman in a press release. “Our findings highlight the need for ongoing, targeted dermatologic care, especially as people with HIV live longer, healthier lives.” He is professor and chair of dermatology at George Washington University and senior author of the paper.

The study, published in the Journal of the American Academy of Dermatology, documented a clear decline in the incidence of new diagnoses, signalling progress linked to improved immune recovery and disease management. Between 2011 and 2024, infectious and inflammatory skin diseases sharply dropped—to 41 from 463 and to 62 from 306 cases per 1,000, respectively. Skin cancers also became rarer, decreasing to six from 31 per 1,000 cases.

Even so, structural inequities in care remained clear. People receiving care in community settings or covered by public insurance were more likely to be diagnosed with skin disease, suggesting barriers to specialized dermatology care. Cisgender women had more than six-fold greater odds of developing cutaneous malignancies compared with other groups.

“Early diagnosis and prompt initiation of HIV treatment remain critical for reducing the long-term risk of both infectious and malignant skin conditions,” said Yagiz Matthew Akiska, the study’s lead author and an MD/MPH candidate at George Washington University. He added that equitable access to dermatologic expertise “is essential to prevent disparities in care and outcomes.”

The study highlights an evolving clinical picture as people with HIV live longer due to potent antiretroviral therapy. Chronic, inflammatory, or age-related skin conditions are becoming increasingly prevalent, echoing trends seen in the general population.

“As the population of people living with HIV ages, chronic skin conditions are becoming more prominent and often persist despite effective HIV treatment,” Akiska said. “Addressing these issues requires integrating dermatology into HIV care, so that patients receive comprehensive support for both their overall health and their quality of life.”

The authors underscore that while HIV care has advanced dramatically, dermatologic health remains an integral—and often overlooked—component of long-term management.