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Relationship Between Onychomycosis and HIV: A Systematic Review
Samantha Cruz-López1,2, Emiret Analy Albavera-Ramírez1,3, Roberto Arenas1
1Micology Section, Hospital General Dr. Manuel Gea González, Mexico City 14080, Mexico.
Journal of Fungi (Basel, Switzerland)
|May 26, 2026
Summary
Fungal nail infections (onychomycosis) in people with HIV often occur with low CD4 counts, though can affect those with partial immune preservation. Trichophyton rubrum is a common cause.
Area of Science:
- Medical Mycology
- Infectious Diseases
- Dermatology
Background:
- Onychomycosis presents unique challenges in individuals with Human Immunodeficiency Virus (HIV), often exhibiting severe or resistant forms.
- Limited data exists on the epidemiology, causative agents, and immune status correlations of onychomycosis in the context of HIV.
Purpose of the Study:
- To systematically review the association between onychomycosis and HIV.
- To analyze prevalence, clinical features, etiologic agents, and CD4+ T lymphocyte counts in HIV-positive individuals with onychomycosis.
Main Methods:
- A systematic review adhering to PRISMA guidelines was performed.
- Searched databases (MEDLINE/PubMed, SciELO, Scopus, Scilit) for studies from October 2015 to July 2025.
- Included case reports, case series, and observational studies of confirmed onychomycosis in people with HIV.
Main Results:
- Thirty studies involving 1296 patients were analyzed; 306 had detailed clinical data.
- The majority of cases originated in the Americas, predominantly affecting males.
- Of 123 patients with CD4+ counts, 52% had counts below 200 cells/µL, with 18 below 50 cells/µL. *Trichophyton rubrum* was the most common pathogen.
Conclusions:
- Onychomycosis in HIV-positive individuals displays diverse etiologies.
- The condition frequently impacts patients with advanced immunosuppression but can also occur with preserved immunity.
- Further standardized prospective research is necessary to elucidate these associations.
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