HIV Rash

Rashes itself is not a diagnosis or a disease but indicate an underlying condition, infection or drug reactions ⁽¹⁾. Most of them are non-infectious or self-limiting. They may appear throughout the body or may be limited to different body parts. The name HIV rash itself is scary. Here the term ‘rash’ is not what scares, but the term ‘HIV’.

It has to be kept in mind that all rashes do not indicate HIV. In people having HIV, they may show rashes in different parts of the body during the course of the disease. Approximately 90% of them experience this symptom during various phases of the illness ⁽²⁾.

These rashes may be due to an infection that occurred due to the decreased immunity, or may be due to the drugs used.

What is an HIV rash?

Those who suffer from HIV infection (Human immunodeficiency virus), have a low immunity due to the decrease in their immune cells in the blood. When the immunity is low, a host of various organisms such as bacteria, virus, fungus and parasites can invade the body to cause diseases.

Human immunodeficiency virus itself may cause rash. Medications that are used in various infective stages can also be a cause of the rash in an HIV patient.

However, in many cases, rashes can be one among the first of the signs that appear in an HIV infected person ⁽¹⁾. So it is important to be evaluated by your doctor.

Rashes Caused by HIV

Many of the viral infections can cause a rash to appear. HIV itself causing rashes is common.

What does an HIV rash look like?

• HIV rashes looks like slightly raised ⁽¹⁾ or flattened areas with redness ⁽²⁾.
• Mostly seen on the face, neck and trunk regions ⁽¹⁾.
• Can be seen on the limbs too ⁽¹⁾.

Picture 1 : Image showing HIV rash appearance.

How does HIV rash look like in different skin colour?

It generally looks reddish in light skinned (fair skinned) people ⁽⁵⁾, whereas in dark skinned HIV rash may appear purplish ⁽¹⁾.

 

 Images show the difference in appearance of HIV rashes with difference in skin colour.

Another image with difference in appearance of HIV rash in skin color

 

Symptoms in early HIV (Acute HIV Rash)

Rashes in HIV can be one of the earliest symptoms. But rashes alone do not indicate HIV infection. What else can be symptoms in an early stage of HIV infection?

• Enlarged lymph nodes ⁽⁴⁾
• Fever ⁽⁴⁾
• Sore throat ⁽¹⁾
• Tiredness ⁽⁴⁾
• Muscle aches (1)
• Headache ⁽¹⁾

These symptoms appear because of the war that is raging between the immune cells of the body and the virus ⁽³⁾. This early stage of HIV is called as Acute HIV and indicates seroconversion. Hence the rashes that appear can be called as seroconversion rash.

Early diagnosis and initiation of treatment for HIV needs to be done in this scenario. Appropriate blood test can help you out to find if you have the virus or not.

Does HIV rash itch?

Acute HIV rashes usually do not itch ⁽²⁹⁾. But if they are caused due to an opportunistic infection, the related symptoms might include itching. You can find the details and characters of different rashes at ‘Atlas of Rashes with Fever’.

Opportunistic infections with rash in HIV

When the immunity of a person is lowered, an opportunity for other organisms such as bacteria, other viruses, fungus and parasites to cause an infection opens up. In a person having HIV infection, the immunity can fall leading to opportunistic infections with the development of AIDS (Acquired Immunodeficiency Syndrome) ⁽⁷⁾.

The rash characters and features are those of the rashes caused by the causative organism. You can find the details and characters of different rashes at ‘Atlas of Rashes with Fever’.

Rashes in HIV can be caused by:

Bacteria

Organism	Skin condition
Staphylococcus aureus (9)	Bullous impetigo Ecthyma Folliculitis
Bartonella henselae and Bartonella Quintana (10, 11, 12)	Bacillary angiomatosis
Mycobacterium tuberculosis and Mycobacterium avium-intracellulare (11, 13)	Cutaneous mycobacterial infection
Treponema pallidum (14, 15)	Primary syphilis Secondary syphilis

 

Virus

Organism	Skin condition
Herpes Simplex virus (16)	Herpes simplex skin lesions
Varicella Zoster virus (17, 18, 19, 20)	Herpes zoster
Molluscum contagiosum (21)	Molluscum contagiosum infection
Human Papilloma Virus (8)	Warts

 

Fungus and Yeast

Organism	Skin condition
Candida and Tinea (8)	Thrush Intertriginous infections Nail, paronychial and foot infections

 

Parasite

Organism	Skin condition
Sarcoptes scabiei (22)	Scabies

 

Neoplasm

Organism	Skin condition
Human Herpes Virus 8 (HHV8) (23, 24, 25)	Kaposi’s Sarcoma

Table: Organisms & Neoplasm along with the condition they cause on the skin in HIV ⁽⁸⁾

Drugs or Medication causing rash

While treating HIV or other infections associated with HIV may cause rash. Sometimes these rashes may occur as a part of allergy towards the medicines. If you have any symptoms such as difficulty in breathing, swelling on face and tongue, visit your doctor immediately.

Check your prescription for any of these medicines. The rashes can occur due to them. In such a scenario, do visit your doctor before the thought of stopping the medicine crosses your mind⁽¹⁾.

• Nevirapine
• Dolutegravir
• Maraviroc
• Raltegravir
• Abacavir

How long does an HIV rash last?

Acute HIV rashes usually persist for around 2-3 weeks. It may disappear by itself before that or may extend to a few more days ⁽²⁶⁾.

If the rash is due to opportunistic infections, the treatment of those infections can help the rashes to disappear earlier ^{(27, 28)}. When the rashes are due to medications, your doctor will help you to shift onto an alternative that does not cause rash. On discontinuation of the earlier medicine, the rashes start to disappear⁽⁸⁾.

Images of HIV rash by different organisms

Picture 4 : HIV rashes on back of a person due to staphylococcal infection.

Picture 5 : An HIV infected person with bacillary angiomatosis.

Picture 6 : HIV rash on face due to Molluscum contagiosum.

Picture 7: Herpes Simplex rashes in HIV

Picture 8 :HIV rash on arm of a patient with Kaposi’s sarcoma

Picture 9 : HIV rash in foot can be seen in this patient with Kaposi’s sarcoma. Plaques of the condition can be noted along with oedema.

Picture 10 : Oral plaque in a patient with HIV associated Kaposi’s sarcoma

Picture 11 : HIV rash on palms of a patient with secondary syphilis

Picture 12 :HIV rash on soles of a patient with secondary syphilis.

Picture 13 :HIV rash in armpit due to fungal (candida) infection.

Picture 14 :Image showing HIV rashes on the head

Picture 15 :HIV rashes on chest

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