Objective Materaly expressed gene 3 ( MEG3), long noncodsne RNA(Lnc RNA ) and micrornA-23b-3p (miR-23b-3p) in relation to the severity of atopic dermatitis (AD) in AIDS patients. Methods Sixty-five AIDS patients with AD admitted to the Department of Infectious Diseases and Dermatology of our hospital from January 2020 to March 2021 were selected as research objects, recorded as the diseased group, and the severity of AIDS patients with AD was assessed on the basis of Scoring Atopic Dermatitis Index (SCORAD). They were recorded as severe group (9 cases), moderate group (36 cases) and mild group (20 cases), and 65 healthy people who underwent physical examination in our hospital were selected as control group. The serum levels of LncRNA MEG3 and miR-23b-3p were detected by qRT-PCR using equal volume blood of the diseased group and the control group, respectively. Starbase database was used to search the target binding sites of both. Pearson method was used to analyze the correlation between the two levels and SCORAD score of AIDS patients. Cox regression model was used to analyze the risk factors of poor prognosis in AIDS patients with AD. The groups were grouped according to the expression levels of LncRNA MEG3 and miR-23b-3p in serum of AIDS patients with AD (the mean expression levels of LncRNA MEG3 and miR-23b-3p in 65 AIDS patients with AD were taken as critical values). The survival curve was drawn and compared by Log-rank method. Results The expression levels of LncRNA MEG3 in serum of the infected group were significantly lower than those of the control group. There were statistically significant differences in the expression levels of LncRNA MEG3 and miR-23b-3p in mild group, moderate group and severe group. Correlation analysis results showed that the serum LncRNA MEG3 level and miR-23b-3p level of AIDS patients with AD were negatively correlated with SCORAD score. Starbase predicted that LncRNA MEG3 and miR-23b-3p had binding sites. There was a positive correlation between LncRNA MEG3 and miR-23b-3p in serum of AIDS patients with AD. Univariate Log-rank analysis showed that the low expression of LncRNA MEG3 and miR-23b-3p were significantly correlated with the shortened overall survival time. Cox regression model was used to analyze the risk factors affecting the prognosis of AIDS patients with AD. Multivariate Cox regression analysis showed that decreased expression level of LncRNA MEG3 and decreased expression level of miR-23b-3p were independent risk factors for poor prognosis in AIDS patients with AD. Conclusion The low expression of LncRNA MEG3 and miR-23b-3p in serum of AIDS patients with AD is related to the severity of the disease, and both are independent risk factors for poor prognosis in AIDS patients with AD.