5 Ways HIV Can Affect Nails

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Nail changes are common in people with human immunodeficiency virus (HIV). While some are caused by the virus itself, others are the result of having a weakened immune system, or side effects of various antiretroviral therapies.

Brittle, damaged nails

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Clubbing

Clubbing—also known ashypertrophic osteoarthropathy—is the thickening and curving of nails around a person's fingertips or toes, and can make nails look like upside-down spoons.

Clubbing may be an early sign of AIDS in pediatric HIV-positive children.

Although there isn't one specific aspect of HIV that causes clubbing, it can be the result of low levels of oxygen in the blood. Clubbing can also be caused by lung diseases, heart disease, and digestive tract conditions.

At the moment, there is no treatment for clubbing.

Melanonychia

Melanonychia is a type of discoloration, which causes vertical black or brown lines on fingernails and/or toenails. Though melanonychia can be a symptom of a number of conditions—including pregnancy, repeated trauma, nail biting, melanoma, and Addison’s disease—those living with HIV are particularly prone to the discoloration. That's because melanonychia can be caused both by the virus itself, in addition to being a side effect of certain drugs used to treat HIV.

If the dark lines on a person's nails appear soon after they begin antiretroviral therapy, the melanonychia is most likely the result of their new medication. This reaction is most closely associated with zidovudine, which, in 1987, became the first antiretroviral approved by the United States Food and Drug Administration (FDA) for the treatment of HIV infection. Given its short intracellular half-life—which requires taking multiple daily doses—zidovudine is less commonly used today.

Other drugs that may cause melanonychia include:

  • Hydroxyurea
  • Methotrexate
  • Phenytoin
  • Chloroquine
  • Beomycin
  • Infliximab

Additionally, several cases have been published featuring people with HIV who develop melanonychia and have not taken antiretroviral therapy. In these people, melanonychia has been associated with mucocutaneous hyperpigmentation caused by increased melanin production resulting from over-expression of a melanocytestimulating hormone. Generally speaking, melanonychia is more prevalent in people with darker skin tones.

Melanonychia Is Not Dangerous

And while melanonychia may not be aesthetically pleasing—not to mention stigmatizing in some cases, given that the condition is associated with HIV—it's not dangerous.

Someone experiencing melanonychia as a result of their HIV medications should discuss the side effect with their doctor in order to determine whether there is a different drug that would work for them without producing these dark stripes on their nails.

Even if that's the case, it can take quite some time for the lines to disappear, and some doctors suggest using nail polish as a way to cover it up.

Onychomycosis

Onychomycosis—also known as tinea unguium—is the medical term for a fungal nail infection. Though anyone can get onychomycosis, the fact that people with HIV have weakened immune systems means that they're more susceptible to getting infections: including those caused by fungus. Onychomycosis can occur in finger- or toenails, though is more common in toenails.

In addition to HIV and other immune system disorders, onychomycosis is more common among people with:

  • Diabetes
  • Peripheral vascular disease
  • Peripheral neuropathies
  • Minor skin or nail injuries
  • Deformed nail or nail disease
  • A family history of nail fungus

The fungal infection can also be caused by skin that stays moist for extended periods of time, including when someone wears shoes that don't allow air to reach their feet.

The signs of onychomycosis include any of the following changes to one or more of a person's nails:

  • Brittleness
  • Change in nail shape
  • Crumbling of the outside edges of the nail
  • Debris trapped under the nail
  • Loosening or lifting up of the nail
  • Loss of luster and shine on the nail surface
  • Thickening of the nail
  • White or yellow streaks on the side of the nail

Though over-the-counter (OTC) creams and ointments are available, they are typically not very helpful in getting rid of onychomycosis. Certain prescription medications taken orally may be able to clear the fungus, but typically take around two to three months to work on toenails (and slightly less for fingernails). Additionally, when a person takes these prescription drugs, their doctor will need to do regular lab tests to check for possible liver damage.

Effectiveness of Medication for Fungal Nail Infections

Medications work for roughly half of the people with fungal nail infections who use them, and even in situations where they do work, it's no guarantee that the fungus won't return.

Occasionally, laser treatments can work on onychomycosis, though they're usually not as effective as medicines. In particularly serious cases, the entire nail might have to be removed in order to deal with the fungal infection.

Anolunula

The white area shaped like a half-moon typically found near the base of a nail is called the lunula. The absence of the lunula is called anolunula, and the condition disproportionately affects people living with HIV. Anolunula can occur in only some of a person's nails, or, in other cases, all of them—which is referred to as "total" anolunula.

A 2014 study found that the number of HIV-positive participants with total anolunula was directly proportional to the stage of their HIV infection: gradually increasing as the HIV infection progress from stage 1 to stage 4. In addition, the researchers observed that presence of either type of anolunula in people with HIV was correlated with their CD4 counts, the time since their diagnosis as being HIV-positive, and whether they were taking antiretroviral therapy.

Though the precise cause of anolunula in people with HIV is not yet known, it is thought that changes in a person's vascular or lymphatic system may be behind the condition.

There are no proven treatments for anolunula.

Terry's Nails

Terry's nails falls under the category of apparent leukonychia: conditions caused by the tissue underneath a nail (also referred to as "subungual tissue").

In a person with Terry's nails, almost all of their nail is opaque and white in color, with the exception of a narrow band of normal, pink color near the top of the nail. In some cases, the nail bed will thicken, and vertical ridging of the nail plate may occur.

Though considered a typical sign of aging, Terry's nails can also be a sign of systemic conditions like HIV, as well as:

  • Cirrhosis
  • Chronic renal failure
  • Congestive heart failure
  • Type 2 diabetes mellitus
  • Acute viral hepatitis
  • Vitiligo
  • Tuberculoid leprosy

And while a specific cause of Terry's nails has not yet been identified, a change in the blood supply to the nail bed, or overgrowth of connective tissue, is thought to be responsible.

There is no treatment for Terry's nails, though they typically go away when their underlying condition is treated.

A Word From Verywell

Whether or not we realize it, our nails can provide us—and our doctors—with important insights into various systemic health conditions, including HIV. Of course, there are many reasons why someone might have most of the nail disorders described above, so even if you notice the signs of a fungal infection, clubbing, or Terry's nails, that doesn't necessarily mean you have HIV. But, given what our nails can tell us about our overall health, it's a good idea to bring up any changes to your nails at your next appointment with your physician.

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