Psoriasis in human immunodeficiency virus (HIV)-positive patients may be severe. Physicians may be tentative to use biologics in HIV-infected patients.
We present an HIV-positive patient with psoriasis who was treated with guselkumab. This paper aims to investigate the safety, efficacy, and tolerability of biologic therapies for HIV-positive patients with psoriasis.
A systematic PubMed review of articles dating between 2000-2018 containing key words psoriasis AND HIV, and psoriatic AND HIV combined with several approved biologic therapies. The review generated 15 articles containing 27 cases of HIV-positive patients treated with etanercept, infliximab, adalimumab, or ustekinumab for their psoriasis.
The majority of cases reported excellent clinical responses, limited adverse events, and well tolerated treatment. CD4 count and viral loads were stable throughout treatment. Similar safety and efficacy were seen in the illustrative case report. Available literature is limited to case reports or case series and could be subject to publication bias of successful cases. Many reports lack quantifiable data and report results based on clinical judgement. No randomized, controlled trials evaluate biologic treatment for psoriasis in HIV-positive patients.
The findings suggest that biologic therapy is an efficacious, safe, and tolerable treatment for most patients with moderate-to-severe psoriasis in HIV-positive patients.