Are Hives a Symptom of HIV?

Hives, or urticaria, are swollen flesh-colored, pink, red, or discolored welts with a pale center that form on your skin. They often cause intense itching or stinging.

Hives occur when your immune system’s mast cells release chemicals, such as histamines, that cause fluid to leak from your small blood vessels.

A 2021 research review showed that up to 20 percent of people get hives at some point in their lives.

Acute hives last from a few days to a few weeks and can be caused by:

• infections
• medications
• insect bites
• food allergies
• contact with allergens such as plants and latex

Acute hives can also be induced by physical agents such as:

• cold temperatures
• sweating or changes in body temperature
• vibration
• water or sunlight (rare)
• exercise

Chronic hives often recur every day or most days, and last from 6 weeks to some months or years. The exact cause is unknown, but conditions with your immune system may play a role.

A 2017 case report noted that hives may be associated with HIV. Because HIV compromises your immune system the following may be more likely to occur:

• hives
• rashes
• other skin conditions

A compromised immune system is more vulnerable to attacks by:

• viruses
• fungi
• bacteria
• parasites
• other causes of hives

Hives also may be due to other health conditions or reactions to medications you may be taking to treat HIV.

A 2019 research review noted that people living with HIV have a 100 times greater chance of experiencing adverse medication reactions such as skin conditions that occur with HIV.

Rashes and skin conditions are common in people living with HIV. Some may be due to HIV, while others may be due to other causes such as certain medications used to treat HIV.

Dermatitis

Dermatitis is quite common and includes different types, such as:

• xerosis cutis: presents as itchy, scaly patches on your arms and legs
• atopic dermatitis: can cause red or discolored, itchy, and scaly rashes that manifest on many areas of your body such as your feet, hands, neck, and eyelids
• seborrheic dermatitis: most often causes redness or discoloration, scales, and dandruff on your scalp and oily areas of your body such as your face, upper chest, and back
• photodermatitis: can cause blisters, dry patches, and rashes on your skin as a result of UV ray exposure
• eosinophillic folliculitis: results in red or discolored itchy bumps within the hair follicles on your scalp and upper body and most often occurs in later stages of HIV
• prurigo nodularis: forms nodules or lumps on your skin that cause an extremely itchy skin rash and a scab-like appearance mostly on your arms and legs

Other infections

Skin conditions in people living with HIV can also be caused by other infections, such as:

• syphilis: a sexually transmitted infection that starts with a painful sore in your mouth or genitals, and a rash that may appear 4 to 10 weeks later
• candidiasis: causes a red or discolored itchy rash to form in the folds of your skin, oral thrush or yeast in your mouth, and painful cracks at the corners of your mouth
• shingles: can lead to painful blisters and skin rashes
• herpes simplex virus: leads to fluid-filled blisters or sores on your mouth, face, and genitals and occurs in the most advanced stage of HIV
• molluscum contagiosum: results in pink or flesh-colored bumps on the upper layers of your skin
• oral hairy leukoplakia: forms thick white or gray patches inside your mouth most likely due to tobacco use
• warts: may look like small cauliflower heads, or nodules of very dry skin, or clusters of small slightly elevated bumps (black dots or seeds are usually invisible)
• genital warts: appear on your genitals, thighs, mouth, and throat and are often dark or flesh-colored with tops that look like cauliflower

Skin cancers

People living with HIV also have a greater chance of developing certain cancers that affect skin, including:

• basal cell carcinoma: forms bumps, growths, sores, scars, or red or discolored patches on your skin’s surface
• squamous cell carcinoma: leads to open sores, red or discolored patches, scales, or warts that form on any part of your skin but most often in areas exposed to UV light
• melanoma: appears to be somewhat large and colorful moles that are uneven, and often start on your face, neck, or chest and back for males and legs for females
• Kaposi sarcoma: forms dark brown or reddish to purple skin lesions in your mouth, nose, genitals, anus, lungs, liver, and digestive tract

Acute HIV symptoms are known as acute retroviral syndrome. They can last for a few days or weeks and may include:

• fever and chills
• headache
• fatigue
• rash
• night sweats
• sore throat
• muscle aches
• joint pain
• swollen lymph nodes (mostly on your neck)
• mouth ulcers

Most of these symptoms resolve by the chronic or latent stage of HIV. Mild swelling in your neck’s lymph nodes may remain.

Talk with a healthcare professional or seek medical care right away if these or any other symptoms persist or worsen.

Be sure to get emergency medical care if you have severe symptoms that persist despite usual or prescribed care, including:

• trouble breathing
• severe headaches
• high fevers

Acute hives usually go away without treatment within a few days. If your hives are triggered by a specific external cause, you should avoid exposure to it if possible.

If needed, a healthcare professional may recommend or prescribe certain medications to help ease itching, swelling, and other symptoms.

Over-the-counter oral antihistamines that may help include:

• diphenhydramine (Benadryl)
• cetirizine (Zyrtec)
• loratadine (Claritin)
• fexofenadine (Allegra)
• levocetirizine (Xyzal)

Prescription medications may include:

• hydroxyzine (Vistaril, Atarax)
• eesloratadine (Clarinex)
• doxepin (Sinequan)

Other medications along with antihistamines include:

• nizatidine (Axid)
• famotidine (Pepcid)
• cimetidine (Tagamet)
• montelukast (Singulair)

If other treatments don’t work for you, a healthcare professional may prescribe a short-term course of steroids, such as prednisone, to help ease severe hives.

An epinephrine injection may also be given for severe reactions or angioedema.

Also, the biologic medication omalizumab (Xolair) may be given for chronic hives that are hard to manage with other treatments.

Skin conditions such as hives may be an early symptom of HIV, but they can also occur at any stage of HIV.

Their causes can vary greatly — some may be due to HIV, while others are due to:

• allergic reactions
• medications
• other causes

Treatments often start with antihistamines, but you may also require short-term use of steroids and other medications.