Living with human immunodeficiency virus (HIV) comes with unique health challenges, including a higher risk of developing nonmelanoma skin cancer as you get older. When skin cancer develops in people living with HIV, it can sometimes be harder to treat and more likely to come back.

This happens because HIV can weaken the immune system (the body’s defense against infection and disease). A weaker immune system may have a harder time finding and destroying abnormal cells before they become cancer.

The good news is that nonmelanoma skin cancers can often be treated successfully when they are found early.

This article looks at the connection between HIV and skin cancer. It covers risk factors, the skin changes to watch for, and the steps you can take to protect your health.

Having HIV Raises Your Risk for Skin Cancer

Nonmelanoma skin cancer most commonly appears as basal cell carcinoma (BCC) or squamous cell carcinoma (SCC). Your risk depends on several factors, including:

• Your age
• How well your immune system is functioning
• Other health conditions

What Research Shows

In a study of more than 43,000 people in a large California health system, people living with HIV were about twice as likely to develop nonmelanoma skin cancer compared with adults who were HIV-negative.

The risk also varies by skin cancer type. A nationwide Danish study of more than 4,000 people with HIV found that, compared with HIV-negative adults, the risk of SCC was about 5.4 times higher and the risk of BCC was about 1.8 times higher.

The increased risk isn’t only about how likely someone is to develop skin cancer. It may also affect the age at diagnosis. People living with HIV tend to develop skin cancer at a younger age than people without HIV.

In one Italian study, among participants who developed skin cancer, people living with HIV were younger on average — 53.7 years versus 68.1 years for HIV-negative controls.

The 2 Most Common Types

Basal cell carcinoma is a slow-growing skin cancer that forms in the basal cells (cells in the deepest layer of the epidermis, the outer layer of skin). It rarely metastasizes (spreads) to other parts of the body, and most people do well when it is found early.

Squamous cell carcinoma forms in the squamous cells (flat cells near the surface of the skin) and is more likely to spread than BCC.

Both types are highly treatable when found early. However, in people living with HIV, SCC in particular may behave more aggressively.

The California health system study found that people with HIV who had very low immune cell counts had a 44 percent higher risk of nonmelanoma skin cancer recurrence (the cancer returning). They also had more than three times the risk of SCC returning specifically.

People living with HIV who develop SCC also tend to be younger at diagnosis and more likely to have the cancer recur in the same area. Some studies suggest they may also have poorer outcomes than people without HIV.

Rarer but More Aggressive Types

Beyond BCC and SCC, HIV is also linked to a higher risk of some less common skin cancers that can be harder to treat.

One example is Merkel cell carcinoma, a rare but more aggressive skin cancer that forms from Merkel cells (specialized skin cells involved in the sense of touch) just beneath the skin’s surface.

Research suggests that people living with HIV may have roughly 13 times the risk of developing it compared with people without HIV.

How Does HIV Affect the Immune System’s Role in Skin Cancer?

Your immune system works like a built-in alarm system. It finds and removes abnormal cells before they can turn into cancer. HIV can interfere with this process in a few important ways.

HIV Can Weaken Your Body’s Cancer Defenses

HIV can lower the number of CD4 cells in your body. These are immune cells that help coordinate your body’s defenses. As CD4 counts drop, the immune system may have a harder time finding and destroying early cancer cells. Research has linked lower CD4 counts with a higher risk of SCC in particular.

However, CD4 counts are only part of the picture. Long-term HIV infection may also contribute to chronic inflammation (ongoing immune system activity) and changes in cell signaling (how cells send messages to each other). These changes may raise cancer risk, even in people who are doing well on treatment.

How HPV and Other Viruses May Raise Skin Cancer Risk

A weakened immune system also struggles to clear human papillomavirus (HPV), a virus linked to SCC — especially in specific body sites such as the anogenital region (the anus, genitals, and nearby skin). When immunity is reduced, HPV can persist longer and may drive skin cancer growth. Research shows that HIV increases the risk of HPV-related cancers specifically.

Other viruses can also be harder to keep under control when the immune system is weakened. These include Epstein-Barr virus (EBV) and hepatitis B and C. Some research has linked these viruses to cancer risk in people living with HIV.

What About Antiretroviral Therapy?

Antiretroviral therapy (ART) helps suppress HIV and protect the immune system. ART isn’t known to increase the overall risk of nonmelanoma skin cancer.

In fact, people with HIV who take ART have a lower rate of developing skin cancer than those who don’t — a reminder that protecting your immune system helps protect against skin cancer too.

That said, some ART medications — including efavirenz and tenofovir disoproxil fumarate — have been linked to drug-induced photosensitivity, meaning your skin may become more sensitive to sunlight.

This isn’t a reason to avoid these medications, but it does make sun protection especially important. Talk with your healthcare provider if you notice unusual skin reactions after sun exposure, especially after starting or changing a medication.

How Can You Help Lower Your Risk for Skin Cancer?

No single step can completely prevent skin cancer, but some practical habits may help lower your risk.

Protecting Your Skin From the Sun

Use broad-spectrum sunscreen with SPF 30 or higher every day, even on cloudy days, since ultraviolet (UV) rays pass through cloud cover. Reapply every two hours when outdoors, as well as after swimming or sweating.

Additionally, wearing protective clothing, sunglasses, and a wide-brimmed hat can help reduce UV exposure.

You should also avoid tanning beds and sunlamps.

If any of your ART medications increase sun sensitivity, sun protection becomes especially important.

Cutting Back on Smoking and Alcohol

Smoking is a known risk factor for nonmelanoma skin cancer, and some studies have linked heavy alcohol use to a higher cancer risk in people living with HIV. Quitting smoking and limiting alcohol may help lower your cancer risk and support your overall health.

Working With Your Care Team

Taking ART as prescribed helps keep the immune system stronger, which may contribute to cancer prevention. Ask your healthcare provider whether any of your medications can increase sun sensitivity and whether HPV vaccination may be appropriate for you.

Some health experts recommend regular skin exams for people living with HIV, especially for those with additional skin cancer risk factors.

Join the Conversation

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