Non-neoplastic cutaneous manifestations of HIV infection in patients from a community-based clinic in Puerto Rico

Authors

  • Itzamar Pastrana-Echevarría Centro Médico Hospital Episcopal San Lucas Department of Graduate Medical Education Research Fellow. 917 Av. Tito Castro, Ponce, Puerto Rico 00733 Author
  • Alicia Báez-Cruz Medical Student, Universidad Central del Caribe School of Medicine, P.O. Box 60327, Bayamón, Puerto Rico 00960, Puerto Rico Author
  • Mileidy Hernández-Nieves Resident Physician, Hospital Pavía Arecibo Carretera 129, Km 1.0 Av. San Luis, Arecibo, 00613 Author
  • Alejandro Pinilla-Baquero Medical Student, Universidad Central del Caribe School of Medicine, P.O. Box 60327, Bayamón, Puerto Rico 00960, Puerto Rico Author
  • Oscar Lugo-Capera Statistical Research, Universidad Central del Caribe School of Medicine, P.O. Box 60327, Bayamón, Puerto Rico 00960 Author
  • Diana Fernández-Santos Associate Dean for Research and Graduate Studies, Universidad Central del Caribe School of Medicine, P.O. Box 60327, Bayamón, Puerto Rico 00960 Author
  • Angel Mayor-Becerra Director of Clinical Center of Universidad Central del Caribe School of Medicine, P.O. Box 60327, Bayamón, Puerto Rico 00960 Author
  • Alexandra Conde-Toro Resident Physician, University of Puerto Rico Medical Sciences Campus PO BOX 365067. San Juan, PR 00936-5067 Author

DOI:

https://doi.org/10.71332/kytmn476

Keywords:

HIV, Skin conditions, Puerto Rico

Abstract

Abstract: Background: Although skin conditions are frequent in people living with HIV (PLWH), no prior studies have described them in Puerto Rico. This study assesses non-neoplastic cutaneous conditions in PLWH at a community clinic. Methods: We performed a cross-sectional analysis of 1,000 PLWH treated from January 2019 to December 2024. Sociodemographic, clinical, and dermatologic data were extracted from electronic records. Descriptive and bivariate analyses (Chi-square or Fisher’s exact) were conducted with p<0.05 considered significant. Results: Non-neoplastic skin conditions were identified in 19.1% of participants (241 diagnoses). The most common were herpes simplex virus (5.3%), dermatitis (2.8%), and warts (2.5%). Longer duration of HIV infection was significantly associated with skin conditions (p=0.004). No associations were found with sex, age, CD4 count, or viral load. Conclusion: Non-neoplastic dermatologic conditions remain prevalent among PLWH in Puerto Rico. These findings support incorporating routine dermatologic assessment into HIV care.

References

1- World Health Organization. HIV and AIDS [Internet]. Geneva: World Health Organization; 2024 Jul 22 [cited 2025 Jul 15]. Available from: https://www.who.int/news-room/fact-sheets/detail/hiv-aids

2- HIV.gov. U.S. Statistics [Internet]. Washington, DC: HIV.gov; 2025 Feb 21 [cited 2025 Jul 15]. Available from: https://www.hiv.gov/hiv-basics/overview/data-and-trends/statistics

3- AIDSVu. Number of persons living with HIV, 2021 [Internet]. Atlanta, GA: Emory University, Rollins School of Public Health; [cited 2024 Mar 24]. Available from: https://map.aidsvu.org/prev/state/case/transmission_msm/none/puerto-rico?geoContext=national&mapOverlays=

4- Chandler DJ, Walker SL. HIV and skin infections. Clin Dermatol. 2024 Mar-Apr;42(2):155-168. doi: 10.1016/j.clindermatol.2023.12.005. Epub 2023 Dec 22. PMID: 38142787.

5- Tschachler E, Bergstresser PR, Stingl G. HIV-related skin diseases. Lancet. 1996 Sep 7;348(9028):659-63. doi: 10.1016/S0140-6736(96)01032-X. PMID: 8782758.

6- Cedeno-Laurent F, Gómez-Flores M, Mendez N, Ancer-Rodríguez J, Bryant JL, Gaspari AA, Trujillo JR. New insights into HIV-1-primary skin disorders. J Int AIDS Soc. 2011 Jan 24;14:5. doi: 10.1186/1758-2652-14-5. PMID: 21261982; PMCID: PMC3037296.

7- Mohseni Afshar Z, Goodarzi A, Emadi SN, Miladi R, Shakoei S, Janbakhsh A, Aryanian Z, Hatami P. A Comprehensive Review on HIV-Associated Dermatologic Manifestations: From Epidemiology to Clinical Management. Int J Microbiol. 2023 Jul 18;2023:6203193. doi: 10.1155/2023/6203193. PMID: 37496761; PMCID: PMC10368516.

8- Gupta AK, Madzia SE, Batra R. Etiology and management of Seborrheic dermatitis. Dermatology. 2004;208(2):89-93. doi: 10.1159/000076478. PMID: 15056994.

9- Garg T, Sanke S. Inflammatory dermatoses in human immunodeficiency virus. Indian J Sex Transm Dis AIDS. 2017 Jul-Dec;38(2):113-120. doi: 10.4103/ijstd.IJSTD_22_17. PMID: 30148263; PMCID: PMC6085932.

10- Cortés-Correa C, Piquero-Casals J, Chaparro-Reyes D, Garré Contreras A, Granger C, Peñaranda-Contreras E. Facial Seborrheic Dermatitis in HIV-Seropositive Patients: Evaluation of the Efficacy and Safety of a Non-Steroidal Cream Containing Piroctone Olamine, Biosaccharide Gum-2 and Stearyl Glycyrrhetinate - A Case Series. Clin Cosmet Investig Dermatol. 2022 Mar 18;15:483-488. doi: 10.2147/CCID.S344807. PMID: 35330623; PMCID: PMC8940309.

11- Clinicalinfo HIV.gov. Varicella-Zoster Virus Disease. Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents with HIV [Internet]. Updated 2022 Sep 7; reviewed 2025 Jan 8 [cited 2025 Jul 15]. Available from: https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-opportunistic-infections/varicella-zoster

12- HIVinfo.nih.gov. HIV and Human Papillomavirus. [Internet]. Bethesda (MD): U.S. Department of Health and Human Services; 2024 Nov 4 [cited 2025 Jul 15]. Available from: https://hivinfo.nih.gov/understanding-hiv/fact-sheets/hiv-and-human-papillomavirus

13- Altman K, Vanness E, Westergaard RP. Cutaneous manifestations of human immunodeficiency virus: a clinical update. Curr Infect Dis Rep. 2015 Mar;17(3):464. doi: 10.1007/s11908-015-0464-y. PMID: 25821188; PMCID: PMC4447481.

14- Diaz I, Neelagaru S, Dall L. Diagnosis of cellulitis in patients infected with the human immunodeficiency virus. Can J Infect Dis. 1994 Mar;5(2):84-5. doi: 10.1155/1994/385971. PMID: 22451771; PMCID: PMC3307408.

15- Oakley A, Brown M, Jarrett P. Skin conditions relating to HIV infection [Internet]. DermNet. 2021 Nov [cited 2025 Jul 15]. Available from: https://dermnetnz.org/topics/skin-conditions-relating-to-hiv-infection

16- Chelidze K, Thomas C, Chang AY, Freeman EE. HIV-Related Skin Disease in the Era of Antiretroviral Therapy: Recognition and Management. Am J Clin Dermatol. 2019 Jun;20(3):423-442. doi: 10.1007/s40257-019-00422-0. PMID: 30806959; PMCID: PMC6581453.

17- Edwards RJ, Lavia LO, Edwards J, Boyce G. Psoriasis in patients attending a large HIV clinic in Trinidad. Med Sci. 2022;10(1):9. doi:10.3390/medsci10010009

18- Chimbetete T, Buck C, Choshi P, Selim R, Pedretti S, Divito SJ, et al. HIV-associated immune dysregulation in the skin: A crucible for exaggerated inflammation and hypersensitivity. J Invest Dermatol. 2023;143(3):362–73. doi:10.1016/j.jid.2022.07.035

19- Lee D, Benson CA, Lewis CE, Grunfeld C, Scherzer R. Prevalence and factors associated with dry skin in HIV infection: the FRAM study. AIDS. 2007 Oct 1;21(15):2051-7. doi: 10.1097/QAD.0b013e3282eea51a. PMID: 17885295; PMCID: PMC3166536.

20- Kaushik SB, Cerci FB, Miracle J, Pokharel A, Chen SC, Chan YH, Wilkin A, Yosipovitch G. Chronic pruritus in HIV-positive patients in the southeastern United States: its prevalence and effect on quality of life. J Am Acad Dermatol. 2014 Apr;70(4):659-664. doi: 10.1016/j.jaad.2013.12.015. Epub 2014 Feb 4. PMID: 24503217.

21- Draganescu M, Baroiu L, Iancu A, Dumitru C, Radaschin D, Polea ED, et al. Perspectives on skin disorder diagnosis among people living with HIV in southeastern Romania. Exp Ther Med. 2021;21:97. doi:10.3892/etm.2020.9529.

22- Ian CT Tse. 21. Dermatologic manifestations in HIV disease. In: HIV Manual 2007 [Internet]. Hong Kong: Department of Health, HKSAR Government; 2007 [cited 2025 Jul 15]. Available from: https://www.aids.gov.hk/pdf/g190htm/21.htm

23- Patel PK, Erlandsen JE, Kirkpatrick WR, Berg DK, Westbrook SD, Louden C, Cornell JE, Thompson GR, Vallor AC, Wickes BL, Wiederhold NP, Redding SW, Patterson TF. The Changing Epidemiology of Oropharyngeal Candidiasis in Patients with HIV/AIDS in the Era of Antiretroviral Therapy. AIDS Res Treat. 2012;2012:262471. doi: 10.1155/2012/262471. Epub 2012 Aug 28. PMID: 22970352; PMCID: PMC3434376.

24- Sendrasoa F, Falimiarintsoa V, Ramarozatovo L, Rapelanoro Rabenja F. Mucocutaneous manifestations among HIV-infected patients in Madagascar: cross-sectional study. JMIR Dermatol. 2023;6:e47199. doi:10.2196/47199. Available from: https://derma.jmir.org/2023/1/e47199

25- Anshory M, Effendi RMRA, Rosandy MG, Kalim H, Nijsten TEC, Schappin R, Nouwen JL, Thio HB. Dermatological manifestation of HIV infection: systematic review and meta-analysis. BMC Infect Dis. 2025 Oct 29;25(1):1446. doi: 10.1186/s12879-025-11827-0. PMID: 41162862; PMCID: PMC12573998.

Downloads

Published

2026-02-27