Prevalence, Incidence, and Risk Factors for Dermatologic Conditions in People with HIV in the Modern Antiretroviral Era: A Cohort Study in Washington, DC

Abstract

Background: Dermatologic disease (DD) remains a significant morbidity among people with HIV (PWH), yet epidemiologic data in the modern antiretroviral therapy (ART) era are limited.

Objective: To characterize the prevalence, incidence, and risk factors of DD among PWH.

Methods: This longitudinal cohort study included 11,738 adults enrolled in the DC Cohort between 2011-2023. DDs were identified using ICD-9/10 codes and categorized as infectious dermatoses, inflammatory dermatoses, or cutaneous malignancies (CM). Prevalence, incidence trends, and multivariable logistic regression were used to identify risk factors.

Results: Among participants, 49.4% had ≥1 dermatologic diagnosis, with infectious conditions most common (41.4%). Incidence declined from 2011-2024 across all categories: infectious (463 to 41), inflammatory (306 to 62), and malignant (31 to 6) cases per 1,000 (all p < 0.0001). Cisgender females had over six-fold greater odds of CM. Lower nadir CD4 count, older age, public insurance, and prior opportunistic infections were associated with higher dermatologic disease risk.

Limitations: Use of ICD codes may have introduced misclassification; dermatology specialty access likely varied by site.

Conclusion: DD incidence has declined over time, reflecting advances in HIV care and treatment. Despite modern ART, DD remains prevalent. Demographic, immune, structural, and behavioral factors drive risk among PWH, underscoring the need for targeted care.

Keywords: HIV; antiretroviral therapy; cohort study; cutaneous malignancy; dermatology; inflammatory dermatoses; skin disease.