Understanding Pruritus (Itching) in People with HIV

March 16, 2024

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If you’re living with HIV (human immunodeficiency virus), you might experience a frustrating and uncomfortable symptom called pruritus, or itching. This itchiness can range from mild to and can greatly impact your quality of life. In this article, we’ll dive into what pruritus is, how it’s related to HIV, and what you can do to manage it.

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What is Pruritus?

Pruritus, commonly known as itching, is an uncomfortable skin sensation that causes the desire to scratch. Some common symptoms of pruritus include:

  • Red, inflamed skin
  • Rash or irritated bumps
  • Dry, cracked skin
  • Burning or tingling sensation
  • Intense urge to scratch

Pruritus can be localized to one area or generalized across large portions of the skin. The severity ranges from mild to severe itching that can negatively impact quality of life.

How Common is Pruritus in People with HIV?

Itching is a very common condition in people living with HIV. According to a study published in the Journal of the International AIDS Society, over 90% of HIV patients experience pruritus during their lifetime.

The prevalence and severity of itching tends to increase as HIV infection progresses and CD4 count drops. Pruritus often signals advanced HIV infection and when it appears for the first time can indicate undiagnosed HIV or failure of antiretroviral treatment.

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What Causes Pruritus in People with HIV?

There are several contributing factors that cause pruritus in individuals with HIV:

Direct effects of HIV

The HIV virus directly attacks the immune system, particularly CD4 T cells. As these cells become depleted, the body’s immune response weakens over time. This allows opportunistic infections and unusual skin conditions to occur, many of which cause pruritus.

The virus also causes systemic inflammation that can prompt mast cell activation in the skin, releasing histamine and other pruritogenic substances. This can lead to itching even without secondary skin conditions.

Skin conditions associated with HIV

People with HIV are prone to developing various skin conditions, either from immunodeficiency itself or as side effects of medications. Many of these have pruritus as a symptom:

  • Eosinophilic folliculitis – Itchy red bumps around hair follicles
  • Seborrheic dermatitis – Red, greasy scales with severe itching
  • Pruritic papular eruption – Severely itchy red bumps on the trunk
  • Atopic dermatitis – Chronic eczema with intense itching
  • Psoriasis – Patches of thick, scaly skin that itch

These conditions often first appear or worsen as CD4 count declines and HIV infection advances.

Medications used to treat HIV

Ironically, medications used to treat HIV can also cause pruritic side effects in some patients, including:

  • Protease inhibitors
  • Non-nucleoside reverse transcriptase inhibitors
  • Entry and fusion inhibitors

The onset of pruritus after beginning a new HIV medication likely indicates a drug reaction.

Other underlying medical conditions

People with advanced HIV are susceptible to numerous other infections that can cause secondary skin irritation and pruritus, like:

  • Fungal infections
  • Viral infections (herpes, shingles)
  • Kidney disease
  • Liver disease
  • Thyroid abnormalities

Diagnosing Pruritus in People with HIV

To determine the underlying cause of pruritus in someone with HIV, a doctor will likely:

Perform a physical examination

Visually inspect the skin for visible rashes, irritation, or lesions. Palpate areas of itching to feel for skins thickening or abnormal texture. Assess the distribution and severity of pruritus.

Take a medical history

Ask questions about the onset, duration, intensity, location, and triggers of itching symptoms. Inquire about medications, preexisting skin conditions, or recent illnesses.

Order diagnostic laboratory tests

Assess current CD4 T cell count to gauge the level of immunodeficiency. Test for HIV viral load, kidney and liver function, blood cell counts, and thyroid hormones.

Perform skin biopsies

Take a small sample of affected skin tissue to analyze under a microscope. Biopsies allow definitive diagnosis of specific skin disorders.

Treating Pruritus in People with HIV

An integrated treatment approach should focus on both alleviating pruritus symptoms and addressing underlying causes:

Treat the underlying condition

Correcting the root condition, whether HIV itself, secondary infections, or skin disorders will reduce inflammation driving pruritus. Antiretroviral therapy to suppress HIV is critical.

Medications for symptom relief

Antihistamines, topical steroids, and anesthetics manage pruritus. Phototherapy or systemic immunosuppressants treat severe cases. But medication side effects may limit options for HIV patients.

Lifestyle measures

Applying cool compresses, wearing loose clothing, using mild cleansers, avoiding irritants, and keeping skin moisturized can temporarily relieve itching. Reducing stress and anxiety also helps.

“For patients with HIV struggling with severe pruritus affecting their quality of life on many levels, I often recommend joining an in-person or online community support group. Connecting with others experiencing similar skin issues can help patients feel less alone as they cope with difficult symptoms.” – Dr. Laura Gates, Infectious Disease Specialist

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When to See a Doctor

Consult your doctor promptly about sudden onset or worsening pruritus, especially if you have:

  • Unexplained fatigue, fever, weight loss, or night sweats
  • New skin rashes, lesions, or hives
  • Swelling of glands or a feeling of “pins and needles”
  • Recent herpes outbreaks with itching
  • Yellowish skin or eyes indicating liver problems
  • Changed urine color due to kidney dysfunction

These red flags can indicate advancing HIV infection, immune reconstitution syndrome, or opportunistic illnesses warranting further evaluation or treatment adjustments. Be alert for medication side effects as well.

Living with Pruritus and HIV

Coping with chronic severe itching combined with an HIV diagnosis deeply impacts one’s daily life. Effective management requires a holistic approach.

Impact on quality of life

Itching can negatively affect mood, concentration, sleep quality, social interaction, and everyday activities. Scratching constantly to find relief can damage skin integrity. Individuals may feel socially isolated or embarrassed by visible rashes.

Coping strategies

To better handle pruritus symptoms emotionally and physically try relaxation techniques, distracted activities, cool baths, hydrocortisone cream, anti-itch balms, calamine lotion, and oral antihistamines. Covering rashes or scars with clothing can reduce social stigma.

Importance of communication with your doctor

Report any new skin changes when they arise and discuss treatment options. Ask about possible drug substitutions if antiretrovirals seem correlated with pruritus flares. Voicing skin-related concerns quickly prevents symptoms spiraling out of control.


  • Pruritus is very prevalent in people living with HIV, occurring in over 90% during their lifetime.
  • Severe itching often signals advancing HIV infection as CD4 count declines.
  • Pruritus results from HIV’s direct effects and secondary skin conditions related to immunodeficiency.
  • Diagnostic tests aid identifying underlying causes, with skin biopsies proving definitive.
  • Treatment involves antiretroviral therapy to control HIV, medications to alleviate itching, and lifestyle measures for comfort.
  • Sudden onset or worsening pruritus warrants prompt medical attention to address its cause.
  • Coping with chronic itching requires both medical and emotional self-care strategies.

Frequently Asked Questions

Is itching always a sign of HIV?

No, pruritus has many causes unrelated to HIV, like dry skin or contact dermatitis. But new onset of severe, persistent, or unexplained itching in high risk individuals warrants an HIV test.

What are some home remedies for itching caused by HIV?

It’s essential to consult a doctor before trying home treatments. Some that may provide temporary relief include oatmeal baths, cold compresses, aloe vera gel, calamine lotion, and keeping the skin moisturized.

Can HIV medications be causing my itching?

Yes, many antiretroviral HIV medications list pruritus as a potential adverse reaction. Let your doctor know if itching symptoms correlate with starting or changing HIV treatment regimens.

How can I manage the emotional impact of constant itching?

Consider joining a support community to connect with others experiencing pruritus. Mental health counselling also helps develop healthy coping strategies for dealing with the frustration of severe, chronic itch.

What should I do if over-the-counter medications aren’t relieving my itching?

Contact your healthcare provider about prescription-strength treatment options. Several classes of medications like antihistamines, topical steroids, anesthetics provide more potent relief of pruritus symptoms. Phototherapy is another option for severe cases.

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