Prevalence, incidence, and risk factors for dermatologic conditions in people with HIV in the modern antiretroviral era: A cohort study in Washington, DC

Authors

Yagiz Matthew Akiska, School of Medicine and Health Sciences, The George Washington University, Washington, District of Columbia; Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia.
Morgan Byrne, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia.
Mana Nasseri, School of Medicine and Health Sciences, The George Washington University, Washington, District of Columbia.
Adeline Koay, Division of Pediatric Infectious Diseases, Medical University of South Carolina, Charleston, South Carolina.
Michael A. Horberg, Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California; Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, Washington, District of Columbia.
Anne Monroe, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia.
Adam Friedman, Department of Dermatology, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia. Electronic address: ajfriedman@mfa.gwu.edu.
Natella Rakhmanina, School of Medicine and Health Sciences, The George Washington University, Washington, District of Columbia; Division of Infectious Diseases, Children's National Hospital, Washington, District of Columbia; Elizabeth Glaser Pediatric AIDS Foundation, Washington, District of Columbia.

Document Type

Journal Article

Publication Date

1-1-2026

Journal

Journal of the American Academy of Dermatology

Volume

94

Issue

1

DOI

10.1016/j.jaad.2025.09.020

Keywords

HIV; antiretroviral therapy; cohort study; cutaneous malignancy; dermatology; infectious disease; inflammatory dermatoses; marginalized population; skin cancer; skin disease

Abstract

BACKGROUND: Dermatologic disease (DD) remains a significant morbidity among people with human immunodeficiency virus (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 and 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 to 2024 across all categories: infectious (463 to 41), inflammatory (306 to 62), and malignant (31 to 6) cases per 1000 (all P < .0001). Cisgender females had over sixfold greater odds of CM. Lower nadir CD4 count, older age, public insurance, and prior opportunistic infections were associated with higher DD 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.

APA Citation

Akiska, Yagiz Matthew; Byrne, Morgan; Nasseri, Mana; Koay, Adeline; Horberg, Michael A.; Monroe, Anne; Friedman, Adam; and Rakhmanina, Natella, "Prevalence, incidence, and risk factors for dermatologic conditions in people with HIV in the modern antiretroviral era: A cohort study in Washington, DC" (2026). GW Authored Works. Paper 8650.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/8650

Department

Dermatology