Biologic Agents Used to Treat Patients With Psoriasis and HIV Infection
Biologic agents combined with antiretroviral therapy showed low risk and high efficacy in patients with psoriasis and concomitant HIV infection.
The use of biologic agents, both anti-tumor necrosis factor-alpha inhibitors and ustekinumab, appear to have an acceptable safety profile and high effectiveness in patients with psoriasis and HIV infection without AIDS, according to the results of the retrospective, multicenter BIOBADADERM study conducted in Spain in 2016. Findings from the study were published in the Journal of Dermatological Treatment.
The investigators sought to assess the efficacy and safety of conventional and biologic immunosuppressive agents for the treatment of patients with psoriasis and concomitant HIV infection. The data included in the current study were collected between 2008 and 2016. Study inclusion criteria were adult patients with HIV with moderate to severe psoriasis, HIV viral load determinations at baseline and at least after 6 months of treatment, documented seropositivity for HIV infection at the initiation of antipsoriatic therapy, and treatment with methotrexate, cyclosporine A, ustekinumab, adalimumab, etanercept, and/or infliximab for 6 months or more.
A total of 23 patients with plaque psoriasis and HIV infection (5 of them with AIDS) were enrolled in the study. The median study follow-up time was 3.2 years; 20 participants were men and 3 were women. The median patient age was 30 (interquartile range, 22-45) years. All participants presented with chronic plaque psoriasis, with most of them having a lengthy median disease duration of 14.4 (interquartile range, 8.4-20.7) years. Overall, 30.4% (7/23) of patients presented with psoriatic arthritis at baseline. Concomitant hepatitis B virus and hepatitis C virus infections were reported in 2 and 8 patients, respectively, with both of these infections coexisting in 1 of the patients.
Of the 23 patients, 18 were infected by serotype 1 HIV. All the patients were receiving antiretroviral therapy at the time of initiation of biologic or conventional immunosuppressive antipsoriatic treatment.
Among the study participants, the median viral load at baseline was 20 copies/mL (interquartile range, 0-80). Overall, 78.2% (18/23) of the patients had viral loads of <100 copies/mL. In 63.1% (12/19) of participants, the baseline CD4 cell count was <500 cells/μL; in 10.5% (2/19) of patients, it was <200 cells/μL.
In most cases, participants' viral loads and CD4 cell counts not only remained stable but also improved throughout the follow-up. Viral loads increased in 3 patients, although the differences were not statistically significant. Moreover, 5 of the patients in whom CD4 cell counts were determined at baseline demonstrated nonstatistically significant decreases. Overall, 90% (18/20) of the patients were considered immunologic responders, with CD4 cell counts >200 cells/μL, and 91.3% (21/23) of the patients were considered virologic responders, with viral loads <400 copies/mL.
Six patients presented with severe adverse events during the follow-up, with 4 of them in the AIDS stage of disease. At the conclusion of the follow-up period, 76.5% of the participants had attained a 75% improvement in Psoriasis Area and Severity Index response.
The investigators concluded that biologic agents seem to exhibit an acceptable safety profile and high efficacy among patients who test positive for HIV with psoriasis and without AIDS. In those patients with AIDS, the risk might be higher. They recommend combining biologic therapy with antiretroviral therapy and closely monitoring adverse events, viral loads, and CD4 cell counts in this patient population, especially patients with AIDS.
Montes-Torres A, Aparicio G, Rivera R, et al; BIOBADADERM Study Group and Psoriasis Group of the AEDV. Safety and effectiveness of conventional systemic therapy and biological drugs in patients with moderate to severe psoriasis and HIV infection: a retrospective multicenter study [published online October 11, 2018]. J Dermatolog Treat. doi: 10.1080/09546634.2018.1535690