There have been a few reports in the literature of chronic actinic dermatitis (CAD) associated with HIV infection, mostly in African–Americans of skin type VI, where photosensitivity predated the diagnosis of HIV infection. We report three cases, all Chinese males with skin type III or IV, who presented to our centre with CAD, and in whom advanced asymptomatic HIV infection was subsequently diagnosed. All had CD4 cell counts less than 100 cells/microL, with no evidence of AIDS-related complex. They were treated conservatively with photoprotection and topical steroids with mild to moderate improvement. A comparison with nine previously reported cases is made. The pathogenesis of CAD is unclear, but predominance of CD8 cells in severe cases and reversal of the CD4:CD8 ratio in lesional skin and peripheral blood of HIV-negative CAD patients has been observed. CAD may be consequent to, and a presenting feature of, advanced HIV infection.