TriNetX Study Maps HIV-Linked Skin Disease Across US Racial Groups

A retrospective cohort study published in the Journal of the American Academy of Dermatology (Volume 95, Issue 5, November 2026) has catalogued the dermatologic conditions associated with HIV among US adults, broken down across racial and ethnic groups.

The work, authored by Sophia Manduca, Li-Chi Chen, Jake Nusynowitz, Kyle Mueller, Andrew Williams, and John C. Trinidad, draws on TriNetX, a large federated electronic health record research network. The retrospective design means the investigators reviewed existing clinical records rather than following patients prospectively, which constrains causal claims but permits a cohort size that single-center studies rarely reach.

Why did the researchers use TriNetX?

TriNetX aggregates de-identified EHR data from dozens of US healthcare organizations, giving dermatology researchers a denominator that reflects real, demographically diverse clinical populations. For a question like HIV-associated skin disease — where presentation and access to care vary sharply by race and ethnicity — network-scale data offers something specialty clinics can't: enough patients in each subgroup to compare condition rates with statistical confidence.

That stratification is the study's core contribution. HIV dermatology literature has historically leaned on cohorts that underrepresent minority groups, even as HIV burden in the US remains concentrated among Black and Latino populations. By reporting condition associations by racial and ethnic category, the authors give clinicians a baseline for what they should expect to see — and screen for — in different patient groups.

What conditions fall under the analysis?

The study examines dermatologic conditions associated with HIV in adults. HIV has long carried a well-documented cutaneous signature: viral infections, inflammatory dermatoses, and malignancies all occur at elevated rates in people living with HIV, and some presentations correlate with immune status. The paper's value lies in quantifying those associations within a modern US cohort and testing whether they hold uniformly across racial and ethnic lines.

The full condition-level results, effect estimates, and cohort sizes appear in the November 2026 issue of JAAD, where the authors report their findings in detail.

What does the design allow — and not allow?

A retrospective EHR cohort has clear strengths: scale, demographic breadth, and real-world treatment settings. It also has limits the authors must navigate in interpretation. Coding accuracy depends on what clinicians entered at the point of care, retrospective data can't establish temporality as cleanly as prospective follow-up, and TriNetX populations skew toward people engaged with large health systems — a group that may differ from unhoused or underinsured patients outside the network.

None of that diminishes the practical takeaway. For dermatologists, the study offers a population-level reference for HIV-associated skin disease in a diverse US adult sample, at a moment when people with HIV are living decades on antiretroviral therapy and their dermatologic needs are shifting accordingly.

Whether the racial and ethnic differences the cohort reveals translate into targeted screening protocols is a question the next prospective study will have to answer.