Can HIV cause hair loss? Yes — though the relationship is multifaceted. HIV does not directly attack hair follicles, but its effects on the immune system, nutritional status, and overall health can create conditions in which hair loss becomes more likely. Certain antiretroviral medications used to treat HIV are also associated with hair changes. Understanding the range of possible causes — from telogen effluvium and scalp infections to medication side effects — is essential for anyone living with HIV who notices changes to their hair. This article explains the key causes, when to seek help, and the treatment options available within the NHS.

How HIV Can Affect Hair Growth and Loss

HIV does not directly attack hair follicles but can disrupt the hair growth cycle through immune suppression, systemic inflammation, and nutritional deficiencies, leading to diffuse shedding known as telogen effluvium.

HIV (human immunodeficiency virus) can affect the body in numerous ways, and changes to hair growth and texture are among the less commonly discussed but clinically recognised concerns. The virus itself does not directly attack hair follicles, but its broader impact on the immune system, nutritional status, and overall health can create conditions in which hair loss becomes more likely.

When HIV is poorly controlled or undiagnosed for a prolonged period, the immune system becomes progressively compromised. This state of immune suppression can disrupt the normal hair growth cycle — known as the anagen (growth), catagen (transition), and telogen (resting) phases. Disruption to this cycle, particularly a shift of follicles into the telogen phase, can result in a type of diffuse hair shedding called telogen effluvium. This is not unique to HIV but is more commonly observed in people with chronic illness.

Additionally, HIV-related inflammation and the body's ongoing immune response can contribute to systemic stress, which is itself a well-established trigger for hair loss. Nutritional deficiencies — particularly in iron, zinc, vitamin D, and B vitamins — may be more prevalent in people with untreated or advanced HIV, or in those with gastrointestinal complications affecting absorption; they are less commonly a significant concern in people with well-controlled infection. Individual assessment is always required.

It is also important to recognise that many people living with HIV experience hair loss for reasons entirely unrelated to the virus — such as androgenetic alopecia (male or female pattern hair loss), which is common in the general population and frequently coexists in people with HIV. Hair loss in this context is therefore rarely caused by a single factor and requires a thorough clinical assessment to identify the underlying contributors. Further information on hair loss causes and when to seek help is available on the NHS hair loss (alopecia) page.

Common Causes of Hair Loss in People Living With HIV

Hair loss in people with HIV most commonly results from androgenetic alopecia, telogen effluvium, seborrhoeic dermatitis, tinea capitis, nutritional deficiencies, or secondary syphilis, requiring individual clinical assessment to identify the cause.

There are several well-documented causes of hair loss that occur more frequently in people living with HIV, many of which are related to the immune and metabolic changes the virus brings about. Common causes unrelated to HIV — most notably androgenetic alopecia — should also always be considered.

Key causes include:

• Androgenetic alopecia — male or female pattern hair loss is the most common cause of hair thinning in the general population and is frequently seen in people living with HIV; it is not caused by HIV itself

• Telogen effluvium — diffuse shedding triggered by physical or emotional stress, illness, or nutritional deficiency, all of which are more common in people with untreated or advanced HIV

• Seborrhoeic dermatitis — an inflammatory skin condition associated with overgrowth of Malassezia yeast on the scalp; it is significantly more prevalent in people with HIV and can cause scaling, inflammation, and associated hair thinning. It is managed with antifungal preparations (such as ketoconazole shampoo) in line with NICE CKS guidance

• Tinea capitis — a dermatophyte fungal infection of the scalp causing patchy hair loss; more likely to occur or persist in immunocompromised individuals and typically requires oral antifungal therapy (see NICE CKS: Tinea capitis)

• Alopecia areata — an autoimmune condition causing patchy hair loss; immune dysregulation in HIV may be a contributing factor in some individuals, though the evidence for a significantly increased prevalence is not robust and this should be assessed on an individual basis (see NICE CKS: Alopecia areata)

• Nutritional deficiencies — low levels of iron, zinc, selenium, and protein are associated with hair loss and are more frequently seen in people with advanced or untreated HIV, or those with malabsorption

• Secondary syphilis — can cause a characteristic 'moth-eaten' pattern of hair loss and should be considered as a differential, particularly given the epidemiological overlap between syphilis and HIV

Psychological factors also play a role. Anxiety, depression, and chronic stress — which are disproportionately experienced by people living with HIV — are recognised triggers for conditions such as telogen effluvium. Addressing mental health as part of holistic HIV care is therefore relevant not only to wellbeing but potentially to hair health as well. A thorough assessment by an HIV specialist or dermatologist is recommended to identify the specific cause in each individual.

Antiretroviral Medications and Hair Loss as a Side Effect

Zidovudine, lopinavir/ritonavir, and efavirenz list alopecia as a recognised adverse reaction in their UK SmPCs; antiretroviral therapy must not be stopped without specialist advice.

Antiretroviral therapy (ART) has transformed HIV from a life-limiting condition into a manageable chronic illness, and the vast majority of people on modern ART regimens tolerate treatment well. However, certain antiretroviral medications have been associated with hair changes, including hair loss, as a recognised adverse effect listed in their UK Summary of Product Characteristics (SmPC).

Medications with documented associations in UK SmPCs include:

• Zidovudine — alopecia is listed as a recognised adverse reaction in the zidovudine (Retrovir) SmPC

• Lopinavir/ritonavir — hair loss is listed as an adverse reaction in the lopinavir/ritonavir (Kaletra) SmPC

• Efavirenz — alopecia has been reported and is referenced in the efavirenz (Sustiva) SmPC

• Indinavir — historically one of the most frequently cited antiretrovirals linked to hair loss and changes in hair texture; now rarely used in the UK

Some case reports and post-marketing data have suggested possible hair changes with other agents, including tenofovir-containing regimens, but the evidence is limited and these associations are not consistently reflected in current UK SmPCs. The MHRA/emc SmPCs and EMA EPARs for individual antiretrovirals should always be consulted for the most up-to-date and complete list of reported adverse effects.

The exact mechanism by which these drugs may cause hair loss is not fully understood and remains uncertain. It is important to emphasise that not all antiretrovirals are associated with hair loss, and many people take these medications without experiencing any hair-related side effects.

Important: Do not stop or change your antiretroviral therapy without first seeking advice from your HIV specialist. Stopping ART can have serious consequences for your health. If hair loss begins or worsens after starting or adjusting ART, discuss this with your HIV care team, who can assess whether a regimen change is appropriate.

If you believe you are experiencing a side effect from an antiretroviral or any other medicine, you can report this to the MHRA via the Yellow Card Scheme at yellowcard.mhra.gov.uk or using the Yellow Card app. Reporting helps improve the safety information available for all medicines.

When to Speak to Your HIV Care Team About Hair Changes

Seek prompt advice from your HIV care team if you notice sudden patchy loss, scalp inflammation, worsening diffuse thinning, or hair changes following an ART adjustment, as these may indicate a treatable underlying cause.

Hair loss can be distressing, and whilst it is not always a sign of a serious underlying problem, there are circumstances in which it warrants prompt clinical attention. People living with HIV should feel empowered to raise concerns about hair changes with their HIV care team, as these changes can sometimes signal broader health issues that require investigation.

Contact your HIV care team or GP if you notice:

• Sudden or rapid hair loss, particularly in patches

• Diffuse thinning across the scalp that is worsening over time

• Hair loss accompanied by scalp redness, scaling, itching, or soreness

• Hair changes that began shortly after starting or adjusting antiretroviral therapy — but do not stop ART without speaking to your HIV specialist first

• Hair loss alongside other new symptoms such as fatigue, weight loss, or skin changes

• Significant emotional distress related to hair loss

Seek urgent dermatology assessment if you notice signs that may suggest scarring alopecia, such as pain, pustules, crusting, or smooth shiny areas of scalp without visible follicular openings. Scarring alopecia can cause permanent hair loss if not treated promptly.

Your HIV care team may refer you to a dermatologist for specialist assessment, or arrange blood tests to investigate potential contributing factors. Typical baseline investigations include full blood count (FBC), ferritin, thyroid function tests, vitamin B12, folate, vitamin D, and zinc levels. Syphilis serology should also be considered where clinically indicated, given the epidemiological overlap with HIV. A scalp examination or, in some cases, a scalp biopsy may be recommended to reach a definitive diagnosis (see NICE CKS: Alopecia areata for referral and biopsy indications).

Hair loss in people living with HIV is often treatable once the underlying cause is identified. Early discussion with your care team means that appropriate investigations and interventions can be initiated sooner. Do not feel that hair concerns are too minor to raise — they are a legitimate part of your overall health and quality of life.

Managing and Treating Hair Loss Linked to HIV

Treatment depends on the underlying cause and may include optimising viral suppression, correcting nutritional deficiencies, treating scalp infections, reviewing the ART regimen, or using licensed options such as topical minoxidil for androgenetic alopecia.

The management of hair loss in people living with HIV depends on identifying and addressing the underlying cause. There is no single universal treatment, and a personalised approach guided by clinical assessment is essential.

General management strategies include:

• Optimising HIV control — ensuring viral load is undetectable through effective ART reduces immune suppression and systemic inflammation, which may improve hair health over time

• Nutritional support — correcting deficiencies in iron, zinc, vitamin D, and B12 through dietary changes or supplementation, guided by blood test results

• Treating scalp conditions — seborrhoeic dermatitis can be managed with antifungal shampoos (such as ketoconazole) in line with NICE CKS guidance; tinea capitis typically requires oral antifungal therapy

• Reviewing ART regimen — if a specific antiretroviral is suspected to be contributing to hair loss, the HIV specialist may consider switching to an alternative agent with a more favourable adverse-effect profile. This decision should always be made by the HIV clinician; do not stop or change ART independently

• Dermatological treatments — for androgenetic alopecia, topical minoxidil (available over the counter in the UK) is a licensed treatment and is widely used; it is licensed specifically for androgenetic alopecia and its use in other hair loss conditions (such as alopecia areata) is off-label with limited supporting evidence. Finasteride (oral, for men) is also a licensed option for male androgenetic alopecia per BNF and NICE CKS guidance; it should be prescribed and monitored by a clinician, with consideration of contraindications and potential interactions. Women of childbearing potential should not handle crushed or broken finasteride tablets. For alopecia areata, treatments such as topical or intralesional corticosteroids and topical immunotherapy may be considered — these are specialist treatments and should only be initiated and supervised by a dermatologist (see NICE CKS: Alopecia areata)

Psychological support, including counselling or referral to NHS Talking Therapies, can also be beneficial given the emotional impact hair loss can have on self-esteem and body image. NICE guidance on the management of specific dermatological conditions should be followed where applicable.

NHS Support and Resources for People Living With HIV

NHS HIV outpatient clinics, GUM clinics, and dermatology services provide specialist care, while organisations such as Terrence Higgins Trust and NAM aidsmap offer additional evidence-based information and support.

People living with HIV in the UK have access to a comprehensive range of NHS services and support organisations that can assist with both the medical and emotional aspects of hair loss and broader HIV-related health concerns.

NHS and specialist services include:

• HIV outpatient clinics — available at most NHS trusts, providing specialist monitoring, ART management, and referral to allied health professionals including dermatologists and dietitians

• Sexual health clinics (GUM clinics) — many also provide HIV care and can offer initial assessment and onward referral; use the NHS Find a Sexual Health Clinic tool at nhs.uk to locate your nearest service

• NHS dermatology services — accessible via GP referral for investigation and treatment of scalp and hair conditions

• NHS Talking Therapies — offering psychological support for anxiety and depression, accessible via self-referral or GP referral in England

Charitable and community organisations that provide additional support include:

• Terrence Higgins Trust (THT) — the UK's leading HIV charity, offering information, advice, and emotional support

• NAM aidsmap — a highly regarded source of evidence-based information about HIV, treatments, and side effects

• Positively UK — a peer-led organisation providing support and advocacy for people living with HIV

• British Association of Dermatologists (BAD) — provides patient information leaflets on conditions including alopecia areata, telogen effluvium, and seborrhoeic dermatitis, available at bad.org.uk

The NHS provides free antiretroviral therapy to all people diagnosed with HIV in the UK, regardless of immigration status, in line with NHS policy and BHIVA standards of care. This ensures that effective viral suppression — which underpins overall health, including hair health — is accessible to all.

If you are concerned about hair loss or any other aspect of your health, your HIV care team is your first and most important point of contact. If you suspect a medicine is causing a side effect, report it to the MHRA via the Yellow Card Scheme at yellowcard.mhra.gov.uk.

Frequently Asked Questions