HIV and Chronic Urticaria (Hives): An Overlooked Connection

By SWA

Chronic urticaria, or chronic hives, is a persistent skin condition marked by recurring, itchy welts that can last for weeks, months, or even years. Though commonly associated with autoimmune diseases, stress, medications, and allergens, chronic urticaria has also been observed in people living with HIV (Human Immunodeficiency Virus). The relationship between HIV and chronic urticaria is complex and often under-recognized, but growing evidence suggests that immune system dysregulation in HIV can contribute to the development or persistence of hives.

What Is Chronic Urticaria?

Chronic urticaria is defined as the occurrence of hives on most days of the week for six weeks or longer. These hives typically appear as red, raised welts or plaques that may sting or burn. Each individual hive usually resolves within 24 hours, but new ones frequently appear in different locations.

Key Characteristics:

  • Duration: Lasts more than six weeks

  • Symptoms: Itching, swelling, and possibly a burning sensation

  • Resolution: Lesions resolve within 24 hours, though the overall condition is long-lasting

  • Types:

    • Chronic spontaneous urticaria (no known trigger)

    • Chronic inducible urticaria (triggered by heat, pressure, cold, etc.)

Who Is at Risk?

Chronic urticaria can affect anyone, but it is more common in:

  • Women (particularly aged 20–40)

  • People with autoimmune conditions (e.g., lupus, thyroid disease)

  • Individuals with chronic infections or immune dysregulation

HIV and Chronic Urticaria: How Are They Linked?

While not as widely discussed as other complications, people living with HIV are at increased risk for chronic urticaria, particularly in the setting of immune system changes.

Possible Mechanisms:

  1. Immune Dysregulation: HIV alters immune system function, often leading to a hyperactive immune response. This dysregulation may result in inappropriate activation of mast cells and basophils—the immune cells responsible for histamine release and hives.

  2. Increased Infection Susceptibility: Opportunistic infections (e.g., fungal, viral, or bacterial) common in HIV can act as chronic immune triggers that lead to urticaria.

  3. Autoimmunity: HIV infection is paradoxically associated with the emergence of autoimmune diseases. Autoimmune urticaria—where the body produces antibodies that activate mast cells—is a known subset of chronic urticaria.

  4. Medications: People with HIV often take multiple medications, including antiretrovirals and antibiotics, which may cause drug-induced hives or exacerbate existing skin issues.

  5. Co-infections: Hepatitis B and C, often seen in co-infected individuals, are also known triggers for chronic urticaria.

Diagnosing Chronic Urticaria in People with HIV

Diagnosis of chronic urticaria in the context of HIV requires a detailed medical history and physical examination. Important steps include:

  • Reviewing medication history

  • Screening for opportunistic infections

  • Testing for autoimmune markers (e.g., thyroid antibodies)

  • Considering allergy testing, although food is a rare cause of chronic hives

Blood tests may also evaluate:

  • Complete blood count (CBC)

  • Liver and kidney function

  • CD4 count and viral load (in known HIV-positive individuals)

Treatment Options

Management of chronic urticaria in people with HIV is similar to treatment in the general population, though it may require closer monitoring due to potential drug interactions and immune status.

First-Line:

  • Non-sedating antihistamines: Such as cetirizine, loratadine, or fexofenadine

Second-Line:

  • Increased antihistamine dosing: Up to 4 times the standard dose may be prescribed safely

  • Leukotriene receptor antagonists: Like montelukast

  • Short-course corticosteroids: For acute flares, used cautiously due to immunosuppressive effects

Advanced Therapies:

  • Omalizumab (Xolair): An anti-IgE monoclonal antibody effective in antihistamine-resistant chronic urticaria

  • Immunosuppressants: Cyclosporine may be used in select cases under close supervision

Important: Any new rash in someone with HIV should be evaluated carefully, as it could signal an allergic reaction, opportunistic infection, or drug toxicity.

Quality of Life and Mental Health

People living with chronic urticaria—especially those with HIV—often experience reduced quality of life due to:

  • Persistent itching and discomfort

  • Sleep disturbances

  • Embarrassment or social withdrawal

  • Anxiety or depression

Mental health support and counseling are crucial components of comprehensive care.

When to See a Doctor

Seek immediate medical attention if you experience:

  • Swelling of the throat, tongue, or face

  • Difficulty breathing or swallowing

  • Dizziness or fainting (may indicate anaphylaxis)

For persistent or unexplained hives—especially in someone with known or suspected HIV—early evaluation can lead to better outcomes and improve symptom control.

Conclusion

Chronic urticaria is more than a skin condition—it is often a sign of deeper immune disturbances, especially in people living with HIV. Understanding the link between HIV and chronic hives is critical for timely diagnosis, effective treatment, and improved quality of life. With the right management strategies, individuals can find relief and live comfortably, even with both conditions.

References:

What to Know About Autoimmune Hives or Rash:
https://www.healthline.com/health/skin/autoimmune-hives

Chronic hives:
https://www.mayoclinic.org/diseases-conditions/chronic-hives/symptoms-causes/syc-20352719

What to Know About Autoimmune Hives or Rash:
https://www.healthline.com/health/skin/autoimmune-hives

Hives:
https://www.mountsinai.org/health-library/diseases-conditions/hives

More References:

  • American Academy of Dermatology (AAD)

  • National Institutes of Health (NIH)

  • HIV Medicine Association

  • World Allergy Organization

© 2000-2025 Sieglinde W. Alexander. All writings by Sieglinde W. Alexander have a fife year copy right. Library of Congress Card Number: LCN 00-192742

Comments

Post a Comment

Popular posts from this blog

Schnitzler Syndrome: A Rare Autoinflammatory Disorder

By SWA
Schnitzler syndrome is a rare, chronic autoinflammatory disease characterized by chronic urticaria (hives), recurrent fever, joint pain, and monoclonal gammopathy (abnormal proteins in the blood). First described by Dr. Liliane Schnitzler in 1972 , this condition is often misdiagnosed, leading to years of untreated symptoms before a correct diagnosis is made. The case report, " A 58-Year-Old Woman With Urticaria, Fever, and Joint Pain " , describes a case that closely aligns with my own experience with this challenging disorder. Key Features of Schnitzler Syndrome Schnitzler syndrome presents with a characteristic set of symptoms, though not all patients experience them in the same way: Chronic Urticaria (Hives) – Persistent, non-itchy or mildly itchy red patches that do not respond to antihistamines. Monoclonal Gammopathy (IgM or IgG type) – Abnormal monoclonal immunoglobulin detected in the blood (most commonly IgM ). Recurrent Fever – Unexplained fever episodes, often...
Read more

Dysferlin Protein: Key Roles, Genetic Locations

By SWA
Image
The purpose of this article is to share and discuss the details of a new discovery, which is highlighted within: CRISPR-Cas9: A Breakthrough Tool to Repair the DYSF Gene The dysferlin protein plays an essential role in maintaining the integrity of muscle cell membranes, particularly in tissues that endure significant mechanical stress, such as skeletal and cardiac muscles . Encoded by the DYSF gene , dysferlin is indispensable for repairing damaged cell membranes after injury caused by muscle contraction or external forces. This article explores the main locations where dysferlin is produced, its role in muscle repair, and supportive nutritional and therapeutic strategies for individuals with dysferlin deficiency, such as those affected by dysferlinopathies (e.g., Limb-Girdle Muscular Dystrophy Type 2B or Miyoshi Myopathy). Currently, there is no definitive answer as to why the severity of dysferlin protein expression or depletion varies. Do pathogens play a role in the methylation o...
Read more

Very Long-Chain Fatty Acids (VLCFAs) X-ALD and Spinal Muscular Atrophy (SMA): Exploring the Connection

By SWA
Update Oct 28th 2024:  A Novel Mouse Model for Cerebral Inflammatory Demyelination in X-Linked Adrenoleukodystrophy: Insights into Pathogenesis and Potential Therapeutic Targets https://onlinelibrary.wiley.com/doi/abs/10.1002/ana.27117 Very Long-Chain Fatty Acids (VLCFAs) are a specific type of fatty acid that are broken down in the body by specialized cellular structures called peroxisomes. These organelles play a critical role in maintaining metabolic balance by degrading VLCFAs. When this process is disrupted, VLCFAs accumulate in various tissues, which can lead to serious metabolic and neurological complications. Elevated VLCFA levels are characteristic of several peroxisomal disorders, most notably X-linked Adrenoleukodystrophy (X-ALD) and Zellweger Syndrome. In X-ALD, for example, a genetic defect impairs the peroxisomal breakdown of VLCFAs, resulting in their accumulation in the brain, spinal cord, and adrenal glands. This buildup can cause progressive neurological damag...
Read more