Side Effects of HIV Medicines

Advances in viral control and immune system preservation have made skin problems less severe and less common. Skin problems that occur due to HIV have also become easier to treat.

HIV Rash: What Does It Look Like and How Is It Treated?

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An itchy rash typically occurs after you contract HIV. It commonly appears on the face and chest but can appear in other places as well. Certain HIV medications may also cause rashes, including serious ones.

Rash as an early symptom of HIV

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A rash is a symptom of HIV that usually occurs within the first two months after contracting the virus. Like other initial symptoms of HIV, it’s easy to mistake this rash for a symptom of another viral infection. Therefore, it’s important to learn how to identify this rash and how to treat it.

According to UC San Diego Health, 90 percent of people who are living with HIV experience skin symptoms and changes at some stage of the disease.

The rash can develop because of conditions caused by HIV, or it can be a side effect of medications that treat HIV, called antiretroviral drugs.

Medication alert

The U.S. Department of Health and Human Services reports that three main classes of antiretroviral drugs are responsible for causing skin rashes:

• non-nucleoside reverse transcriptase inhibitors (NNRTIs)
• nucleoside reverse transcriptase inhibitors (NRTI)
• protease inhibitors (PIs)

NNRTIs such as nevirapine (Viramune) are the most common cause of medication skin rashes. Abacavir (Ziagen) is an NRTI drug that can cause skin rashes. The most likely PIs to cause rashes are amprenavir (Agenerase) and tipranavir (Aptivus).

Whether caused by an HIV medication or by HIV itself, the rash typically appears as a red, flattened area on the skin that’s usually covered with small red bumps.

A main symptom of the rash is itchiness. It can show up on any part of the body, but it most often occurs on the face and chest, and sometimes on the feet and hands. It can also cause mouth ulcers.

Range of severity

Some HIV rashes are mild. Other rashes can cause serious damage to the skin, causing them to be life-threatening.

One rare but potentially serious skin rash that can develop through the use of antiretroviral drugs is Stevens-Johnson syndrome (SJS). When this condition covers 30 percent of the body, it’s called toxic epidermal necrolysis. The symptoms of SJS include:

• blisters on the skin and mucous membranes
• a rash that develops quickly
• fever
• swelling of the tongue

Advances in viral control and immune system preservation have made skin problems less severe and less common. Skin problems that occur due to HIV have also become easier to treat.

The most common form of treatment to manage HIV rash is medication. Depending on the cause of the rash, over-the-counter drugs such as hydrocortisone cream or diphenhydramine (Benadryl) may be helpful for reducing itchiness and rash size. More serious rashes may require prescription medication from a healthcare provider.

Lifestyle changes

In addition to medication, some lifestyle changes may help alleviate the symptoms of the mild form of this rash. Avoiding heat and direct sunlight can improve some rashes. Hot showers and baths can make the rash worse.

Sometimes, starting a new medication, trying a new soap, or eating a particular food may coincide with the development of a rash. In this case, it’s possible an allergy may be the cause. People living with HIV should contact their healthcare provider if they notice a rash and are not sure about the cause.

Someone who is unsure about the cause of their rash and thinks that they may have been exposed to HIV should make an appointment with their healthcare provider. Let them know of any skin changes that have developed. This will help the healthcare provider make a diagnosis.

Last medically reviewed on January 26, 2018

Side Effects of HIV Medicines

HIV and Opportunistic Infections, Coinfections, and Conditions

Living with HIV

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Key Points

• A rash is an irritated area of the skin that is sometimes itchy, red, and painful.
• Possible causes of a rash in people with HIV include acute HIV infection, other infections, some HIV medicines, and other medicines.
• A rash due to an HIV medicine is often not serious and goes away in several days to weeks without treatment. But sometimes when an HIV medicine is causing a rash, it may be necessary to switch to another HIV medicine.
• If you have HIV, tell your health care provider if you have a rash. A rash that may not seem serious can be a sign of a life-threatening condition that requires immediate medical attention.

Why do people with HIV develop a rash?

A rash is an irritated area of the skin that is sometimes itchy, red, and painful. Possible causes of a rash in people with HIV include:

• Acute HIV infection
• Other infections
• HIV medicines
• Other medicines

Acute HIV infection

Acute HIV infection is the earliest stage of HIV infection. Symptoms of acute HIV infection may include a rash.

Other infections

Without treatment, HIV gradually destroys the immune system. Damage to the immune system puts people with HIV at risk of infections, and a rash is a symptom of many infections.

Medicines

Many medicines, including some HIV medicines, can cause a rash.

A rash due to an HIV medicine is often not serious and goes away in several days to weeks without treatment. But sometimes, when an HIV medicine is causing a rash, it may be necessary to switch to another HIV medicine.

If you are taking HIV medicines, tell your health care provider if you have a rash. In rare cases, a rash caused by an HIV medicine can be a sign of a serious, life-threatening condition.

What are serious rash-related conditions?

A rash can be a sign of a hypersensitivity reaction. A hypersensitivity reaction is a potentially serious allergic reaction to a medicine. In addition to a rash, signs of a hypersensitivity reaction can include difficulty breathing, dizziness, or lightheadedness. A severe hypersensitivity reaction can be life-threatening and requires immediate medical attention.

Stevens-Johnson syndrome (SJS) is a rare but life-threatening hypersensitivity reaction reported with the use of some HIV medicines. People taking HIV medicines need to know about this condition. It rarely occurs, but when it does, it can cause death.

Symptoms of SJS include fever, flu-like symptoms, rash, and painful blisters that may spread throughout the body.

If you have symptoms of SJS, get medical help immediately. SJS can be life-threatening.

This fact sheet is based on information from the following sources:

From the Department of Health and Human Services:

• Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents Living with HIV:
  • Acute and Recent (Early) HIV Infection
  • Adverse Effects of Antiretroviral Agents

  From the National Institutes of Health: National Center for Advancing Translational Sciences:

  Also see the HIV Source collection of HIV links and resources.