Race Linked to Increased Risk for Pruritic Skin Conditions in People With HIV

A woman of African descent and her doctor are indoors in a medical clinic. They are sitting and talking about the woman’s health problems.
Black patients with HIV may be at increased risk for pruritic disorders compared with race-matched controls and white patients with HIV.

Black patients with HIV were at higher risk for pruritic and inflammatory skin diseases compared with white patients with HIV, according to cross-sectional study data published in the Journal of the American Academy of Dermatology,.

Investigators obtained medical record data for patients age ≥18 years with and without HIV seen at Johns Hopkins Hospitals in Baltimore, Maryland, between July 14, 2013 and July 14, 2018. Patients with HIV were identified from diagnosis, billing diagnosis, or a problem list entry indicating HIV. The comparison population comprised patients who did not have HIV who presented to the hospital within the same period. The burden of HIV-related dermatologic conditions was assessed via medical records. The odds ratios (OR) for each dermatologic diagnosis were calculated in patients with and without HIV. Additional analyses were stratified by race. Significance was assessed through Chi-squared testing.

During the study period, 346,950 controls and 4679 patients with HIV were seen at Johns Hopkins Hospitals. The majority of patients (88.7%) with HIV were receiving anti-retroviral therapy. More than half of control patients (58.6%) were women compared with 35.3% of patients with HIV. Of patients with HIV, 26.1% were white and 69.0% were black.

The results demonstrated a cumulative total of 48 skin conditions observed in >0.1% of the cohort; patients with HIV were at increased risk for 29 of them (60.4%). Of note, patients with HIV had 135-fold higher odds of having Kaposi sarcoma than matched controls (OR 135.54; 95% CI, 91.99-199.71). Overall, the most common skin conditions that occurred in patients with HIV were atopic dermatitis (18.2%), verruca vulgaris (16.8%), herpes simplex (14.5%), cellulitis (14.4%), and dermatophytosis (11.7%).

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In race-stratified analyses, black patients with HIV had significantly increased odds of many of the same diagnoses observed in the overall HIV-positive cohort. Most significant, these patients had increased odds of developing Kaposi sarcoma (OR 134.11; 95% CI, 62.82-286.30). In addition, black patients were at increased risk for oral hairy leukoplakia (OR 64.69; 95% CI, 12.55-333.57), herpes zoster (OR 9.27; 95% CI, 7.97-10.77), prurigo nodularis (OR 8.80; 95% CI, 7.16-10.81), and squamous cell carcinoma (OR 5.72; 95% CI, 4.12-7.94) compared with controls. In white patients with HIV, results also demonstrated a significantly higher risk for Kaposi sarcoma (OR, 198.34; 95% CI, 114.78-342.74).  These patients were also at higher risk for genital warts (OR 9.66; 95% CI, 6.62-14.09), herpes simplex (OR 6.20; 95% CI, 5.29-7.27) and tinea capitis (OR 5.97; 95% CI, 2.44-14.57) compared with white controls.

These data underscore the increased risk for dermatologic conditions in patients with HIV. Significant racial differences in the risk for certain dermatologic conditions were also observed, with black patients experiencing inflammatory and pruritic skin conditions more often than both black controls and white patients. Given that these data were abstracted from only one healthcare system, results must be extrapolated with care. Even so, the data indicated that “greater awareness is needed for the detection and management of commonly associated dermatologic conditions in this patient population, particularly with regards to racial differences,” investigators wrote.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures

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Bender AM, Tang O, Khanna R, Ständer S, Kang S, Kwatra SG. Racial differences in dermatological conditions associated with human immunodeficiency virus: a cross-sectional study of 4,679 patients in an urban tertiary care center [published online September 6, 2019]. J Am Acad Dermatol. doi:10.1016/j.jaad.2019.08.072