Main Article Content
HIV, Psoriasis, Biologics
Refractory psoriasis poses a significant challenge to dermatologists, and comorbid conditions may further exacerbate that challenge. This is especially true for conditions that compromise a patient’s immune status—such as human immunodeficiency virus (HIV)—as many of the most potent medications in the psoriasis armamentarium rely on immunomodulation. Moreover, patients with HIV are often excluded from clinical trials because of their immunocompromised state. Therefore, most treatment recommendations rely on anecdotal evidence derived from case reports and case series. This article reviews the current recommendations regarding management of HIV-associated psoriasis, with a particular focus on the relatively recent use of biologic agents in this population. Though there is a risk of compounding patients’ suppressed immune status, the reports to date have demonstrated promise in treating refractory HIV-associated psoriatic disease, and these agents may play a role in managing appropriately selected patients.
Menon K, Van Voorhees AS, Bebo BF Jr, et al. Psoriasis in patients with HIV infection: from the medical board of the National Psoriasis Foundation. J Am Acad Dermatol. 2010;62:291.
Mallon E, Bunker CB. HIV-associated psoriasis. AIDS Patient Care & Stds. 2000;14:239-46
Monteleone G, Pallone F, MacDonald TT, et al. Psoriasis: from pathogenesis to novel therapeutic approaches. Clin Sci (Lond). 2010;120(1):1-11.
Fischer T, Schwörer H, Vente C, et al. Clinical improvement of HIV-associated psoriasis parallels a reduction of HIV viral load induced by effective antiretroviral therapy. AIDS. 1999;13:628.
De Simone C, Perino F, Caldarola G, et al. Treatment of psoriasis with etanercept in immunocompromised patients: Two case reports. J Int Med Res. 2016;44:67-71.
Morar N, Willis-Owen SA, Maurer T, et al. HIV-associated psoriasis: pathogenesis, clinical features, and Management. Lancet Infect Dis. 2010;10:470-78.
Kaplan MH, Sadick NS, Wieder J, et al. Antipsoriatic effects of zidovudine in human immunodeficiency virus-associated psoriasis. J Am Acad Dermatol. 1989; 20:76.
Duvic M, Crane MM, Conant M, et al. Zidovudine improves psoriasis in human immunodeficiency virus-positive males. Arch Dermatol. 1994;130:447.
Mahajan VK, Sharma NL, Sarin S, et al. Triple antiretroviral therapy improves psoriasis associated with human immunodeficiency virus infection: a clinico-therapeutic experience. J Eur Acad Dermatol Venereol. 2008;22:1017.
Mamkin I, Mamkin A, Ramanan SV. HIV-associated psoriasis. The Lancet Infectious Diseases. 2007;7:496.
Vittorio Luigi De Socio G, Simonetti S, Stagni G. Clinical improvement of psoriasis in an AIDS patient effectively treated with combination antiretroviral therapy. Scand J Infect Dis. 2006; 38:74.
Günthard HF, Saag MS, Benson CA, et al. Antiretroviral Drugs for Treatment and Prevention of HIV Infection in Adults: 2016 Recommendations of the International Antiviral Society-USA Panel. JAMA. 2016;316:191.
Gray JD, Bottomley W, Layton AM, Cotterill JA, Monteiro E. The use of calcipotriol in HIV-related psoriasis. Clin Exp Dermatol. 1992;17:342-3.
BreuerMcHam J, Marshall G, AduOppong A, et al. Alterations in HIV expression in AIDS patients with psoriasis or pruritus treated with phototherapy. J Am Acad Dermatol. 1999; 40:48.
Meola T, Soter NA, Ostreicher R, et al. The safety of UVB phototherapy in patients with HIV infection. J Am Acad Dermatol. 1993; 29:216.
Ranki A, Puska P, Mattinen S, et al. Effect of PUVA on immunologic and virologic findings in HIV-infected patients. J Am Acad Dermatol. 1991;24:404-10.
Pechère M, Yerly S, Lemonnier E, et al. Impact of PUVA therapy on HIV viremia: a pilot study. Dermatology. 1997; 195:84.
Cavard C, Zider A, Vernet M, et al. In vivo activation by ultraviolet rays of the human immunodeficiency virus type 1 long terminal repeat. J Clin Invest. 1990; 86:1369.
Fotiades J, Lim HW, Jiang SB, et al. Efficacy of ultraviolet B phototherapy for psoriasis in patients infected with human immunodeficiency virus. Photodermatol Photoimmunol Photomed. 1995;11:107-11.
Buccheri L, Katchen BR, Karter AJ, Cohen SR. Acitretin therapy is effective for psoriasis associated with human immunodeficiency virus infection. Arch Dermatol. 1997;133:711.
Masson C, Chennebault JM, Leclech C. Is HIV infection contraindication to the use of methotrexate in psoriatic arthritis? J Rheumatol. 1995;22:2191.
Maurer TA, Zackheim HS, Tuffanelli L, et al. The use of methotrexate for treatment of psoriasis in patients with HIV infection. J Am Acad Dermatol. 1994;31:372-5.
Allen BR. Use of cyclosporin for psoriasis in HIV-positive patient. Lancet. 1992;339:686.
Tourne L, Durez P, Van Vooren JP, et al. Alleviation of HIV-associated psoriasis and psoriatic arthritis with cyclosporine. J Am Acad Dermatol. 1997;37:501.
Rosmarin DM, Lebwohl M, Elewski BE, et al. Cyclosporine and psoriasis: 2008 National Psoriasis Foundation Consensus Conference. J Am Acad Dermatol. 2010; 62:838.
Calabrese LH, Zein N, Vassilopoulos D. Safety of antitumor necrosis factor (anti-TNF) therapy in patients with chronic viral infections: hepatitis C, hepatitis B and HIV infection. Ann Rheum Dis. 2006;65:983-9
Mikhail M, Weinberg JM, Smith BL. 2008. Successful treatment with etanercept of von Zumbusch pustular psoriasis in a patient with human immunodeficiency virus. Arch. Dermatol. 144:453– 456.
Linardaki G, Katsarou O, Ioannidou P. Effective Etanercept Treatment for Psoriatic Arthritis Complicating Concomitant Human Immunodefiency Virus and Hepatitis C Virus Infection. J Rheumatol. 2007;34(6):1353-5.
Di Lernia F, Zoboli G, Ficarelli E. Long-term Management of HIV/Hepatitis C Virus Associated with Etanercept. Indian J Dermatol Venereol Leprol. 2013;79(3):444.
Bardazzi F, Magnano M, Campanati A, et al. Biologic Therapies in HIV-infected Patients with Psoriasis: An Italian Experience. Acta Derm Venereol. 2017;97(8):989-990.
Aboulafia DM, Bundow D, Wilske K, et al. Etanercept for the treatment of human immunodeficiency virus-associated psoriatic arthritis. Mayo Clin Proc. 2000; 75:1093.
Scallon B, Cai A, Solowski N, et al. Binding and functional comparisons of two types of tumor necrosis factor antagonists. J Pharmacol Exp Ther. 2002; 301:418-26.
Cepeda EJ, Williams FM, Ishimori ML, et al. The use of anti-tumour necrosis factor therapy in HIV-positive individuals with rheumatic disease. Ann Rheum Dis. 2008; 67:710.
Sellam J, Bouvard B, Masson C, et al. Use of infliximab to treat psoriatic arthritis in HIV-positive patients. Joint Bone Spine. 2007; 74:197.
Bartke U, Venten I, Kreuter A, et al. Human immunodeficiency virus-associated psoriasis and psoriatic arthritis treated with infliximab. Br J Dermatol. 2004; 150:784.
Wieder S, Routt E, Levitt J, et al. Treatment of Refractory Psoriasis with Ustekinumab in an HIV-Positive Patient: A Case Presentation and Review of the Biologic Literature. Journal of Psoriasis and Psoriatic Arthritis. 2014;20(3):96-102.
Saeki H, Ito T, Hayashi M, et al. Successful treatment of ustekinumab in a severe psoriasis patient with human immunodeciency virus infection. J Eur Acad Dermatol Venereol. 2015;29:1653-1655.
Yannam GR, Gutti T, Poluektova LY. IL-23 in infections, inflammation, autoimmunity and cancer: possible role in HIV-1 and AIDS. J Neuroimmune Pharmacol. 2012;7:95-112.
Paparizos V, Rallis E, Kirsten L, Kyriakis K. Ustekinumab for the treatment of HIV psoriasis. J Dermatolog Treat. 2012;23:398.
Carpentieri A, Silvestris R, Mascia P, et al. Evaluation of Efficacy and Safety of Biological Therapy in Patients with Psoriasis and HIV Coinfection. J Am Acad Dermatol. 2017;76(6):AB128.
Patel RV, Weinberg JM. Psoriasis in the Patient with Human Immunodeficiency Virus, Part 2: Review of Treatment. Cutis. 2008;82(3):202-10.