Dry skin affects up to half of adults with HIV

Dry skin is a pervasive problem among HIV-positive men and women, affecting up to one out of every two people with HIV according to a recent report by researchers in the United States. The study, published in the October issue of AIDS, also found that use of the protease inhibitor indinavir (Crixivan) increased the risk of having dry skin.

Skin problems

Skin problems are common with HIV infection. Though some researchers have noted that dermatologic conditions have decreased since the introduction of effective antiretroviral therapy, studies still report a prevalence of dry skin between 19 to 28% among people with HIV.

With colleagues, Carl Grunfeld at the University of California, San Francisco set out to determine the prevalence of dry skin among people with HIV. The researchers evaluated skin dryness by self-report and medical examination among a cross-sectional cohort of 1026 HIV-positive participants and 274 HIV-negative participants of the Study in Fat Redistribution and Metabolic Changes in HIV infection (FRAM).

The prevalence of self-reported dry skin among people with HIV was significantly higher than among HIV-negative participants: 42.1% among HIV-positive men compared with 9.9% for HIV-negative men, and 51.5% among HIV-positive women compared with 31.6% among HIV-negative women. The researchers found that similar results were seen when clinicians evaluated skin dryness. Overall, women had a higher prevalence of self-reported dry skin than men. However, there was no difference based on ethnicity.

Multivariate analysis revealed than HIV-positive men were 5.7 times more likely than uninfected men to report dry skin. HIV-positive women were 2.2 times more likely than uninfected women to report dry skin. The researchers point out that this difference is likely due to the higher prevalence of reported dry skin among HIV-negative women. The researchers also noted that HIV-negative men may not notice their skin as much as HIV-positive men, leading to the large difference in self-reported dryness.

Because of the difference in reporting by gender, the researchers proceeded with an analysis by gender of factors associated with self-reported dry skin in HIV infection.

In men, dry skin was associated with: a CD4 cell count below 200 cells/mm³ (odds ratio [OR] 1.58); having an opportunistic infection within the last 100 days (OR 1.80); the current use of the protease inhibitor indinavir (OR 1.96); and inadequate food intake (OR 1.80).

The association of indinavir use and dry skin was higher among men with a CD4 cell count above 200 cells/mm³ (OR 2.29) than those with a lower CD4 count (OR 1.02).

In women, dry skin was associated with low CD4 cell count (OR 2.00), but not with recent opportunistic infection, indinavir use or food intake. In women, crack cocaine use was associated with a decreased risk of dry skin (OR 0.30).

In both sexes, dry skin was not associated with ethnicity, age, body mass index or undetectable viral load (below 400 copies/ml).

Of all the antiretrovirals, indinavir had the strongest association with dry skin. It was the only association to reach statistical significance, though the researchers noted that other drugs and protease inhibitor class as a class tended in the same direction.

Indinavir interferes with the metabolism of retinoids, a group of compounds involved in skin renewal, and dry skin is a side effect of the drug. The nucleoside analogue 3TC (lamivudine, Epivir) is also associated with dry skin, though the mechanism of action is not known.

The researchers note that many of these relationships have been observed in other studies. They highlight that continued research is needed to better understand the relationship between the factors identified here and the dry skin commonly seen with chronic HIV infection.