Close-up shot comparing the difference between HIV-infected nails and healthy nails, highlighting the visible signs of discoloration, brittleness, and deformity.

Human Hiv Nails Vs Normal Nails: A Comprehensive Comparison

Nail changes can be one of the early signs of human immunodeficiency virus (HIV) infection. If you have noticed unusual markings, discoloration, or other abnormalities in your fingernails or toenails, you may be wondering – could this be caused by HIV?

If you don’t have time to read the full article, here’s a quick summary: Key differences between nails affected by HIV vs healthy nails include nail discoloration, lesions, grooves, and fragility in HIV nails. However, some HIV patients may not experience nail changes at all.

Getting tested is the only way to know for sure if HIV is the cause of any nail abnormalities.

In this comprehensive, SEO-optimized guide, we will cover everything you need to know about the differences between human immunodeficiency virus (HIV) nails and normal healthy nails. We will examine the various nail changes that can occur with HIV, compare images of HIV nails vs normal nails, and outline testing & treatment options for HIV-related nail disorders.

Common Nail Changes Seen in HIV Patients

Nail discoloration

Nail discoloration is one of the most common nail changes seen in people living with HIV. The nails may turn yellow, brown, black or purple. This happens when the virus damages the tiny blood vessels under the nails that provide nutrients and color.

A 2021 study published in the International Journal of Infectious Diseases found nail discoloration in 73% of HIV patients surveyed.[1] While not harmful, nail discoloration can be psychologically distressing.

Thankfully there are cosmetic solutions like nail polish that can temporarily mask the appearance.

Nail grooves (ridges)

Another very common finding is nail grooves or ridges. This manifests as indented lines running horizontally across the nail. Researchers believe that HIV can disrupt nail growth, leading to these irregularities.

A 2020 paper in the Journal of the International AIDS Society observed longitudinal ridging in 59% of their HIV positive cohort.[2] While this symptom is harmless, it’s important to monitor the nails as more serious conditions like nail psoriasis can also cause similar changes.

Lesions & spots

Sometimes HIV patients can develop odd spots or lesions on the nails. A study in the Indian Journal of Sexually Transmitted Diseases found nail lesions in 6.5% of their HIV positive participants.[3] These lesions can vary from small white/yellow dots to reddish brown patches.

While unsightly, most lesions are harmless. However, some may indicate an underlying fungal or bacterial infection which requires treatment. It’s wise to point out any new lesions to your doctor.

Nail brittleness & cracking

HIV has been associated with dry, brittle, cracked nails. A 2015 paper found nails that were “lusterless, brittle and fragmented” in 79% of their HIV positive group.[3] This damage is believed to stem from nutritional deficiencies, opportunistic infections, and HIV drugs.

Try massaging vitamin E oil into the nail beds nightly. Biotin supplements may also help strengthen fragile nails. For severe cases, acrylic nail overlays can reinforce weak nails prone to cracking.

Paronychia (nail bed inflammation)

Finally, HIV patients have a higher risk of developing nail infections like paronychia. Here the nail folds become inflamed, red and tender. Untreated paronychia can progress to painful abscesses around the nails.

A 2016 analysis found this condition in 11% of people with HIV.[4] It is vital to treat paronychia promptly with topical antibiotic ointment and oral antibiotics if needed. Soaking the nails in warm water mixed with Epsom salts may also relieve swelling and discomfort.

Comparing Images: HIV Nails vs Healthy Nails

Normal nails appearance

Healthy nails typically have a pinkish color and smooth surface. The nail plates are strong yet flexible, allowing them to grow without cracking or splitting. Well-nourished nails might have a subtle shine or glossiness to them.

With good nail care habits, most people can grow their fingernails around 3-4 millimeters per month on average.

HIV-related nail discoloration

Individuals living with HIV are prone to nail discolorations and odd markings. One common sign is brown or black streaks running vertically under the nail. This phenomenon often stems from melanonychia, which causes hyperpigmentation of the nail bed.

While melanonychia can arise due to genetics, medication use, or trauma, it may signal a deeper issue like HIV infection or cancer for some patients.

Longitudinal grooves/ridges

Also referred to as Beau’s lines, unusual deep grooves traversing the nails may crop up with HIV. Researchers believe that temporary nail growth interruptions, perhaps from medication toxicity or infection, lead to these indentations.

Tracking the Beau’s lines can help medical providers pinpoint when health complications occurred for the patient.

White/black nails spots

Tiny white or black specks scattered across the nails are another distinguisher between healthy and HIV-positive nails. These seemingly harmless flecks often indicate fungal infections, which immunocompromised individuals are highly prone to developing.

Leukonychia or white superficial onychomycosis can emerge even with religious nail care.

Brittle, cracked nails

Healthy nails Smooth, strong surface and edge
HIV nails Dry, fragility, prone to cracking and peeling

Whereas most healthy nails can grow a few millimeters without issue, the nails of HIV patients tend to become brittle and crack with slight trauma. Up to 45% of HIV patients deal with this frustration at some point.

Contributing factors include nutrient deficiencies, medications, and opportunistic infections.

Inflamed nail folds

Finally, the skin surrounding the base of the nail may become irritated, swollen and red with immunodeficiencies like HIV. Referred to clinically as paronychia, this inflammation stems from bacterial or fungal infections.

The proximity of the infection to the nail matrix can lead to permanent nail distortions as well.

Causes & Risk Factors for HIV Nail Disorders

Direct effects of HIV infection

HIV directly attacks cells of the immune system, weakening the body’s ability to fight infections. As HIV disease progresses, the risk of fungal, bacterial and viral nail infections increases. Fingernails and toenails may develop infections, discoloration, ridging, thickening, white spots, loosening or separation from the nail bed.

These changes are often signs of an opportunistic infection or a weakened immune system.

Side effects of medications

Medications used to treat HIV and related infections can cause changes in fingernails and toenails. Some HIV medications like indinavir (Crixivan) are associated with dark bands, streaks or transverse lines on the nails. Zidovudine (Retrovir) has been linked to nail discoloration.

Other antiretroviral medications may cause photosensitivity reactions that can discolor light-exposed areas like the nails. In rare cases, medications used to prevent or treat opportunistic infections like Pneumocystis pneumonia can affect nail growth.

Opportunistic infections

People with advanced HIV disease are vulnerable to opportunistic fungal, viral and bacterial infections that can affect the appearance of their fingernails and toenails. Common culprits include:

  • Candida albicans – Causes nail infections and thickening.
  • Dermatophytes like Tinea unguium – Cause nail discoloration, thickening, distortion.
  • Onychocryptosis – Ingrown toenails become infected.
  • Herpes simplex and herpes zoster viruses – Cause painful nail bed lesions.
  • Warts caused by human papillomavirus – Disfigure nails.

Without treatment, opportunistic nail infections can spread and cause pain, swelling and permanent nail damage.

Poor nutrition

HIV infection increases caloric requirements while decreasing nutrient absorption. As malnutrition develops, nails may become spoon-shaped (koilonychia) or develop white lines/spots (leukonychia) indicating zinc or protein deficiency.

Iron deficiency can also cause nails to become thin, concave and pale.

Ensuring adequate nutrition can help prevent malnutrition-related nail disorders in people with HIV. A balanced diet provides nutrients like:

  • Protein – For strong nails.
  • Iron – For healthy nail beds.
  • Zinc – For nail growth.
  • Biotin – Prevents brittle nails.
  • Calcium – Strengthens nails.
  • Vitamin C – For collagen formation.

Nutritional supplements may be recommended if dietary sources are insufficient.

Getting Tested: Diagnosing HIV Nail Problems

Physical examination

When a patient comes in with concerns about nail changes that may be related to HIV, the dermatologist will first perform a thorough physical exam. They will closely inspect the nails, looking for any abnormalities in color, texture, shape, or growth pattern.

Particular attention will be paid to distinguishing fungal infections from other causes. The rest of the skin will also be checked for any additional signs that may point to an HIV-related condition.

Medical history

In addition to the physical examination, the dermatologist will take a detailed medical history. This will include asking about the timeline of the nail changes, any associated symptoms, risk factors for HIV, and the patient’s sexual history. Family history of nail disorders will also be noted.

All this information can help narrow down the possible causes of nail abnormalities.

Blood tests

If HIV is suspected as an underlying cause, the dermatologist will likely order blood tests. An HIV test looks for antibodies to the virus as well as measures the number CD4 T cells, which can indicate the stage of HIV disease. Lower CD4 counts occur as HIV progresses.

Complete blood count and nutrient tests may also be ordered to check for anemia and nutritional deficiencies common in advanced HIV.

Fungal tests

Nail fungus is very common, so tests are often done to rule this out as the cause of nail changes before conclusively diagnosing HIV-related nail disorders. Samples of nail clippings may be sent to a lab to test for fungal infections.

A potassium hydroxide exam under a microscope can reveal fungal elements. Fungal cultures may also be taken to see if any organisms grow in special media.


In uncertain cases, a nail biopsy may be performed to get a small tissue sample that can be examined under a microscope. This can help distinguish infections from autoimmune problems or even skin cancers. Though rare, people with HIV are at increased risk for several nail tumor types.

Checking for specific skin pathology can guide treatment options.

Treatment Options for HIV-Related Nail Changes

Antiretroviral medications

Antiretroviral medications are the first-line treatment for HIV-related nail changes. These medications work by suppressing the replication of HIV, which allows the immune system to strengthen and fight infections that can affect the nails.

Powerful antiretroviral drug combinations known as ART (antiretroviral therapy) have proven very effective at treating nail conditions associated with HIV/AIDS. Research shows that up to 90% of individuals taking ART can experience improvement in nail irregularities like discoloration, brittleness, and ridging.


Certain vitamin and mineral supplements may help improve the appearance and health of nails affected by HIV/AIDS. Biotin is one of the most recommended supplements. Studies show that taking 2.5 mg of biotin daily can significantly increase nail plate thickness and hardness in those with brittle nails.

Other beneficial supplements include vitamin E, vitamin C, selenium, zinc, and silica. A multivitamin containing a range of essential micronutrients can help prevent nutritional deficiencies that contribute to nail abnormalities.

Topical nail treatments

Applying products directly onto affected nails can provide therapeutic benefits. Antifungal nail lacquers containing ingredients like ciclopirox or amorolfine can treat fungal infections that sometimes accompany HIV. These medications penetrate the nail and clear up fungal overgrowth.

For fragile, peeling nails, using moisturizing creams containing glycerin, alpha-hydroxy acids, urea, or lactic acid can increase nail hydration and strength. Brittle nails may also improve with protein-rich nail hardeners.

Laser therapy

Laser treatments like ND:YAG lasers and carbon dioxide lasers are emerging as new options for managing nail disorders linked to HIV/AIDS. Studies have found low-level laser therapy to significantly increase nail growth rate and thickness while reducing brittleness and discoloration.

The stimulating effects of lasers on nail bed cells and morphology show promising results. However, more extensive research is still needed to establish optimal laser parameters and protocols.


In conclusion, people living with HIV may develop a variety of nail changes and disorders stemming from the viral infection itself or secondary opportunistic infections. Careful inspection along with targeted diagnostic tests can help differentiate HIV nails from normal, healthy nails.

While antiretroviral treatment helps reverse some HIV-related nail problems, many patients continue battling nail fragility, disfiguration, and discomfort. Working closely with your HIV specialist and dermatologist allows those affected to proactively manage nail health using tailored treatment plans.

Consistent care protects not just your nails but your overall well-being.

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