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A 21 year old man saw his GP in London for a non-itchy skin rash. The GP found abnormal results in liver function tests and referred him to a gastroenterologist. While waiting for a liver biopsy the patient moved to Swansea University and consulted the university doctor, who had some experience of working with HIV. The patient was born in Africa and had immigrated to the United Kingdom aged 12 years. His father had died from tuberculosis in Africa. He denied ever using intravenous drugs, although he'd had several injections in Africa for malaria. Severe acne prompted an HIV test, the result of which was positive. Genotype testing showed subtype C, which is common in Africa. His viral load indicated advanced HIV disease. Worsening of previous acne, late onset, or severe forms of acne have all been reported in patients infected with HIV.HIV.