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4 Ways HIV May Affect Your Nails

Medically reviewed by Barry S. Zingman, M.D.
Posted on August 28, 2023

Your nails may not seem like they’d be very important from a medical viewpoint, but they’re actually little windows into your overall health. If you have human immunodeficiency virus (HIV), the infection can lead to certain changes to and infections of your fingernails and toenails. Understanding these potential effects is important for managing your overall health while living with HIV, a virus that attacks the immune system.

In this article, we’ll discuss how HIV may affect your nails and when you should seek medical advice for your symptoms.

1. Clubbing

Clubbing is a condition in which the nail bed and fingertip appear enlarged and rounded due to an increase in soft tissue. This symptom can be a sign of many underlying health issues, including lung and heart diseases.

Several health conditions, including HIV, can cause clubbing fingernails. Excess soft tissue in the fingertip makes the nails look swollen. (CC BY-NC-ND 3.0 NZ/DermNet)

Sometimes, clubbing is found in people living with HIV. In one small study, 36 percent of people being treated for HIV at one clinic had clubbed nails. The researchers didn’t find any difference in the health status of people with and without clubbing — the two groups didn’t vary in viral load (the amount of HIV in their body) or CD4 cell count (a measure of immune system strength). However, people who had clubbed nails were, on average, younger and had had HIV longer than those without clubbing.

Additionally, clubbing may be an early sign of AIDS in children who were born with HIV.

If you’re living with HIV and notice clubbed nails, discuss this symptom with your doctor at your next primary care appointment. It’s likely that the clubbing can be attributed to your HIV, but other conditions that cause clubbing should also be ruled out if you have relevant risk factors.

2. Melanonychia

When the nail plate has a black or brown stripe due to a buildup of melanin (the pigment that gives your skin its color), this is called melanonychia. This dark stripe often runs up and down, known as longitudinal melanonychia. This phenomenon is quite common, affecting up to 23 percent of some populations, and has a variety of causes.

Melanonychia is found fairly often in the general population, but these vertical dark stripes on the nails are even more common in people living with HIV. (CC BY-NC-ND 3.0 NZ/DermNet)


One study found that people living with HIV were more likely to experience melanonychia than people without HIV. The researchers noted that two factors increased risk of melanonychia — having darker skin and using the antiretroviral treatment (ART) zidovudine, which can be used alone (Retrovir) or combined with lamivudine (Combivir). It’s not known exactly why zidovudine, a medication known as nucleoside reverse transcriptase inhibitor, causes melanonychia as a side effect.

Melanonychia may not be aesthetically pleasing, but it’s not painful or harmful. For people who are living with HIV, have dark skin, or have taken zidovudine, this nail feature is fairly common. However, melanonychia has many other causes, including melanoma (skin cancer) and Cushing’s syndrome (a hormonal imbalance), so it’s important to tell your doctor if you notice this symptom.

3. Anolunula

To understand the term “anolunula,” it’s important to know that the white semicircles at the base of nail beds are called lunula. With anolunula — ”absence of lunula” — lunula aren’t visible. Some researchers have noted that anolunula is more common in people who have HIV than in those who don’t. In one study, anolunula was correlated with CD4 count, HIV stage, and time since diagnosis, increasing along with a higher count, stage, and length of time.

Anolunula is the absence of the white semicircles, known as lunula, at the base of your nails. (CC BY 3.0/Pratik Gahalaut et al.)


It’s always important to attend regular doctors’ appointments to check how well your medications are working to treat your HIV. If you notice that you have anolunula, this may suggest that it’s time to schedule another appointment to get an evaluation of your health and current treatment plan.

4. Onychomycosis

Onychomycosis, a chronic fungal infection of the nail plate, accounts for half of nail diseases treated by doctors. The infection turns toenails and fingernails white, but it’s usually not harmful.

Onychomycosis is a fungal infection that can occur in anyone, whether or not you have HIV. (CC BY-NC-ND 3.0 NZ/DermNet)


Because of their weakened immune systems, people with HIV may get opportunistic infections — infections that occur more easily in people with HIV compared with the general population. “Is anyone else dealing with opportunistic infections?” one myHIVteam member asked.

Onychomycosis is a type of opportunistic infection because it’s more common in people living with HIV than in people who don’t have HIV.

Originally, researchers thought that a lower CD4 count made a person more likely to get fungal nail infections, but more recent studies show that these factors aren’t necessarily linked. However, if you notice yourself getting infections, including fungal infections, more often, it’s important to check with your doctor to evaluate if your current treatment plan is working well and you’re following it properly.

Fungal foot infections can be prevented with good foot hygiene tips provided by the American Academy of Dermatology Association. For example:

  • Keep your feet clean and dry.
  • Air out sweaty shoes before wearing them again.
  • Regularly trim nails to keep them short.

Onychomycosis is treated with antifungal therapy, whether that’s a pill taken by mouth or a cream or ointment applied to the nail. Because ART can interact with many medications, it’s important to speak with your doctor to get treatment for your fungal infection. Don’t start a new medication, even if it’s over the counter, without the advice of your doctor.

Speak to Your Health Care Provider

As someone living with HIV, you know that nail problems, rashes, and other skin symptoms can be a cause for concern. It may be difficult to share your HIV status with a new doctor, but if you see a dermatologist for your skin or nail symptoms, it’s important to let them know that you’re living with HIV. As always, make sure to share any new symptoms or side effects — even if they’re not painful or bothersome — with your primary care doctor. These symptoms can offer clues to your health status and let you know when to ask for help in taking control of your HIV.

Talk With Others Who Understand

On myHIVteam, the social network for people with HIV and their loved ones, more than 37,000 members come together to ask questions, give advice, and share their stories with others who understand life with HIV.

Have you noticed any nail changes — such as discoloration, clubbing, or infections — since your HIV diagnosis? Do your nails look different since starting antiretroviral treatment? Share your experience in the comments below, or start a conversation by posting on your Activities page.

    Posted on August 28, 2023
    All updates must be accompanied by text or a picture.

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    Barry S. Zingman, M.D. specializes in HIV/AIDS medicine and general infectious disease. Review provided by VeriMed Healthcare Network. Learn more about him here
    Scarlett Bergam, M.P.H. is a medical student at George Washington University and a former Fulbright research scholar in Durban, South Africa. Learn more about her here

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