Study Links Structural and Immune Risk Factors to Skin Conditions in PWH

KEY TAKEAWAYS

• Almost 50% of people with HIV had at least one skin condition, with infectious dermatoses most prevalent, new data indicate.

• Dermatologic disease incidence declined between 2011 and 2023.

• Demographic, immune, and structural factors continue to influence dermatologic outcomes in HIV care.

Nearly half of people living with HIV (PWH) are diagnosed with at least one dermatologic condition despite advances in antiretroviral therapy (ART), according to a longitudinal cohort study published through the DC Cohort.

According to a press release published with the study, researchers examined data from 11,738 adults in Washington, D.C., between 2011 and 2023 to assess the prevalence, incidence, and risk factors for dermatologic disease (DD) among PWH in the modern ART era. Infectious skin conditions (including fungal infections, herpes, and viral warts) were the most common diagnoses, occuring in 41.4% of participants. Almost half (49.4%) of study subjects had at least one DD diagnosis.

The incidence of all dermatologic conditions declined significantly over the course of the study, with infections dropping from 463 to 41 cases per 1000, inflammatory dermatoses from 306 to 62, and cutaneous malignancies from 31 to 6 (allP < 0.0001). Despite the overall decline, however, the data also revealed lingering disparities. Multivariable regression identified older age, lower nadir CD4 count, public insurance, prior opportunistic infections, and being cisgender female as independent risk factors for DD. Patients receiving care in community settings were more likely to be diagnosed with skin disease.

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

Sources:

Akiska Y, et al. JAAD. 2025. doi:10.1016/j.jaad.2025.09.020

GWU press release, October 14, 2025.