Skin rashes and lesions are some of the most common signs and symptoms experienced in HIV infection. There is no single definitive HIV rash – individuals may have different types of rashes of varying severity, distribution, and appearance.
As there are many other conditions that can also cause skin rashes, including allergies, autoimmune conditions, and other infections, it is important to remember that there is no way to diagnose someone with HIV based solely on the presence of a rash. Conversely, there is also no way we can rule out HIV just because someone does not have a skin rash. The only way to know for sure is by doing an HIV test at the appropriate time.
Acute HIV Seroconversion HIV Rash
In the primary stage of HIV infection, viral replication progresses quickly and the viral load (VL) will be very high. Your body’s immune system will detect the virus and start producing HIV antibodies to try and fight off the virus – this process is called seroconversion. It is this activity of the immune system which can manifest in the typical symptoms of acute HIV infection, also known as Acute Retroviral Syndrome (ARS) – with fever, swollen lymph nodes, and rashes being the most common symptoms.
The seroconversion HIV rash usually develops around 2-6 weeks from exposure. It will appear as reddish macules (flat lesions) and papules (small swollen bumps) spread over a generalized region, typically over the chest, back, and abdomen, sometimes extending to the arms and legs as well. It can be very itchy for some people, but not always. Symptoms of itch can be reduced by antihistamines and topical creams.
These rashes may last a few weeks or months, but will eventually resolve by themselves, even if the HIV infection has not been diagnosed and treated. This happens as the HIV antibodies bring down the viral load and infected individuals enter the clinically latent stage (chronic HIV infection). Many people may have missed the diagnosis of HIV if they were told by a doctor their rash was due to some allergy or viral flu but did not get tested properly.
When a person contracts HIV, they are also at increased risk of other infections. Some of these are sexually transmitted and can be contacted at the same time as HIV (e.g. syphilis, herpes simplex virus, etc.), while some can occur later in the disease due to a weakened immune system (e.g. candida/thrush). These infections can also cause skin rashes or lesions to develop, so it is important to look out for any abnormal skin changes if you are concerned about any potential exposure risk, and also to inform your doctor of your concerns.
Syphilis is a sexually transmitted infection caused by the bacteria Treponema Pallidum and is commonly diagnosed together with new HIV infection as they share common risk factors. The primary stage of syphilis infection is a painless chancre or ulcer at the primary site of infection (usually genital, rectal, or oral), but it may go unnoticed by many people. The secondary stage of syphilis is a skin rash which can look very similar to acute HIV rash, with reddish papules around the trunk, arms and legs, and usually over the palms and soles as well – most of the time, this rash is not itchy or painful. Most people who present with a skin rash after potential exposure risk should be tested for both HIV and syphilis together.
Herpes Simplex Virus
Another sexually transmitted infection, herpes simplex virus (HSV) can cause small crops of fluid-filled blisters that can start off looking like a reddish rash. They are usually slightly itchy or painful, and may then burst to form small ulcers which will then dry and crust over. Sometimes, the initial herpes outbreak may be preceded by some viral, flu-like symptoms including fever and swollen lymph nodes. There is no ‘cure’ for herpes, but usually, your immune system will help to control the infection and keep it dormant, although reactivation and clinical outbreaks can still occur (around 2-3x per year on average). Herpes can be contracted both together with acute HIV or can recur frequently in late-stage HIV – persistent or chronic HSV lesions in the setting of untreated or late-stage HIV is considered an AIDS-defining illness, as the immune system has been weakened by the HIV virus and can no longer keep the HSV infection suppressed.
Not quite a rash, but rather an abnormal growth of capillary blood vessel tissues, Kaposi Sarcoma (KS) is actually a type of cancer that can be found in late-stage HIV.
It is caused by an infection with human herpesvirus 8 (HHV-8) which is an opportunistic infection and is also considered an AIDS-defining illness as the transformation of the skin cells only occurs in the presence of a weakened immune system. KS appears as either a single or multiple reddish purplish bumps over the skin or mucous membranes.
They are usually painless and not itchy but can cause other symptoms if they grow on internal organs such as the gastrointestinal tract or the lungs (e.g. GI bleeding, shortness of breath, etc.).
Also, read the 10 Common HIV-Related Opportunistic Infections (IOs)
Also known as thrush, candida is a very common fungal organism that is found in the environment and can be isolated from around 30-50% of healthy people. Most of the time, it does not cause any symptoms of infection; however, in people with a weakened immune system, there may be an invasive overgrowth of the organism which leads to symptoms. Common areas of candida infection are the nails, skin, mouth/tongue, and genital region. Depending on the region affected, symptoms may include an itchy rash, with scaly or flaking skin, sometimes with a soft whitish layer which can be scraped off.
These are just some of the different types of skin rashes and lesions that may be present in an HIV infection. There is no single type of HIV rash that we can consider to be diagnostic by itself. It is important to assess clinical features of the rash, timing, and potential exposure risk. At the end of the day, the only way to diagnose an HIV infection will be through appropriate HIV testing at any of our clinics.
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Other Interesting Reads:
- The HIV Pro-Viral DNA Test can be done 10 days post-exposure.