1
|
Abstract
Patients living with HIV may experience a variety of inflammatory dermatoses, ranging from exacerbations of underlying conditions to those triggered by HIV infection itself. This article presents a current literature review on the etiology, diagnosis and management of atopic dermatitis, psoriasis, pityriasis rubra pilaris, lichen planus, seborrheic dermatitis, eosinophilic folliculitis, pruritic papular eruption and pruritus, in patients living with HIV.
Collapse
Affiliation(s)
- Robert Bobotsis
- Division of Dermatology, Department of Medicine, Faculty of Medicine, University of Toronto School of Medicine, Toronto, Ontario, Canada
| | - Shakira Brathwaite
- Division of Dermatology, Department of Medicine, Faculty of Medicine, University of Toronto School of Medicine, Toronto, Ontario, Canada
| | - Panteha Eshtiaghi
- Division of Dermatology, Department of Medicine, Faculty of Medicine, University of Toronto School of Medicine, Toronto, Ontario, Canada
| | - Fabian Rodriguez-Bolanos
- Division of Dermatology, Department of Medicine, Faculty of Medicine, University of Toronto School of Medicine, Toronto, Ontario, Canada
| | - Philip Doiron
- Division of Dermatology, Department of Medicine, Faculty of Medicine, University of Toronto School of Medicine, Toronto, Ontario, Canada.
| |
Collapse
|
2
|
Estevinho T, Freitas E, Torres T. Risankizumab, a therapeutic alternative for psoriasis in people living with HIV. J Int Med Res 2024; 52:3000605241229324. [PMID: 38470310 PMCID: PMC10935762 DOI: 10.1177/03000605241229324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 01/13/2024] [Indexed: 03/13/2024] Open
Abstract
The management of psoriasis in individuals with human immunodeficiency virus (HIV) presents a unique challenge, marked by a more severe progression and limited efficacy of first- and second-line treatments. Although conventional systemic therapies might be considered, these agents are immunosuppressants, making their use challenging in people living with HIV (PLHIV). Biologic agents are frequently used in individuals with moderate-to-severe psoriasis, but their efficacy and safety data in PLHIV are very limited, as this patient group tends to be excluded from clinical trials. Risankizumab is a selective interleukin-23 (IL-23) inhibitor that has demonstrated a favourable safety profile and high efficacy in long-term studies and clinical practice. This current case report presents two clinical cases of PLHIV with plaque psoriasis who were effectively treated with the biologic agent risankizumab, with no reported safety issues. Although there are limited data on the use of biologics in PLHIV, this case series suggests that IL-23 inhibitors, namely risankizumab, might be a valuable therapeutic option for this population. Additional research and larger studies are needed to gain a more comprehensive understanding of the long-term safety and efficacy of IL-23 inhibitors in individuals affected by HIV.
Collapse
Affiliation(s)
| | - Egídio Freitas
- Department of Dermatology, Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - Tiago Torres
- Department of Dermatology, Centro Hospitalar Universitário de Santo António, Porto, Portugal
- Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Porto, Portugal
| |
Collapse
|
3
|
Hill B, Mitchell A. Psoriasis: overview, treatments and implications for nursing care. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2023; 32:462-465. [PMID: 37219982 DOI: 10.12968/bjon.2023.32.10.462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Affiliation(s)
- Barry Hill
- Assistant Professor of Nursing and Critical Care, Northumbria University, Newcastle upon Tyne
| | - Aby Mitchell
- Senior Lecturer in Nursing Education, King's College London
| |
Collapse
|
4
|
Bang AS, Hakimi M, Tahir P, Bhutani T, Leslie KS. Biologic Therapies in HIV/AIDS Patients with Inflammatory Diseases: A Systematic Review of the Literature. AIDS Patient Care STDS 2023; 37:215-242. [PMID: 37083445 DOI: 10.1089/apc.2022.0197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023] Open
Abstract
Biologic therapies have been increasingly developed and used for the treatment of severe inflammatory diseases. However, the safety and efficacy profile of biologic drugs in patients with HIV is not well established as this patient population is historically excluded from clinical trials. We review the available evidence of biologic use in people with HIV. We conducted a systematic review of the literature up to June 29, 2022 and included studies that treated patients with HIV who have inflammatory disease using biologic drugs. Clinical data regarding safety and efficacy were abstracted into tables. One hundred twelve studies were included, and 179 patients were included in our study. Nearly all classes of biologics drugs had a favorable safety profile with minimal or minor adverse events. Anti-CD-20 inhibitors and TNF-alpha inhibitors were associated with opportunistic infections. Transient increase in HIV viral load was noted with use of some agents such as TNF-alpha inhibitors. The quality of evidence is low, restricted to case reports and retrospective reviews. However, the safety profile of biologics observed in these patients with HIV was overall favorable.
Collapse
Affiliation(s)
- Alexander S Bang
- Department of Dermatology, Weill Cornell Medicine, New York, New York, USA
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Dermatology, Stanford Medicine, Redwood City, California, USA
| | - Marwa Hakimi
- Department of Dermatology and University of California San Francisco, San Francisco, California, USA
| | - Peggy Tahir
- UCSF Library, University of California San Francisco, San Francisco, California, USA
| | - Tina Bhutani
- Department of Dermatology and University of California San Francisco, San Francisco, California, USA
| | - Kieron S Leslie
- Department of Dermatology and University of California San Francisco, San Francisco, California, USA
| |
Collapse
|
5
|
Xu J, Gill K, Flora A, Kozera E, Frew JW. The impact of psoriasis biologic therapy on HIV viral load and CD4 + cell counts in HIV-positive individuals: A real-world cohort study. J Eur Acad Dermatol Venereol 2023. [PMID: 36897246 DOI: 10.1111/jdv.19020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 02/15/2023] [Indexed: 03/11/2023]
Abstract
BACKGROUND Psoriasis is a chronic immune-mediated inflammatory disorder that also occurs in the setting of human immunodeficiency virus (HIV). Biological therapy has transformed the treatment landscape for psoriasis; however, individuals with HIV are excluded from clinical trials. The impact of biological therapy on blood parameters in HIV is unclear and is only observed in small case series. OBJECTIVE The aim of this study was to assess the effect of biological therapy in psoriasis vulgaris in individuals with well-controlled HIV on CD4+ cell counts, CD4+ proportion and HIV viral load over 12 months. METHODS This retrospective cohort study was conducted at a tertiary referral centre in Sydney, Australia and included 36 HIV-positive individuals with psoriasis treated with biological therapy, compared with 144 age-, gender- and HAART-matched individuals without psoriasis seen between 2010 and 2022. Outcomes of interest included HIV viral load, CD4+ cell count and incidence of infections. RESULTS No statistically significant difference was seen in baseline HIV viral load and CD4+ count between individuals with and without psoriasis. No significant change in CD4+ count or HIV viral load was seen over the 12-month period of analysis in the HIV cohort without psoriasis. The HIV cohort treated with biological therapy for psoriasis also did not demonstrate any significant change in HIV viral load and CD4+ counts over the 12-month period examined. Stratification by type of biological therapy used did not identify any significant changes in these parameters. Rates of infections and adverse events were also not significantly different between cohorts. It is possible that minor blips seen in the biologics cohort may be a risk factor for future virological failure, and future prospective longitudinal studies are required. CONCLUSIONS In individuals with well-controlled HIV, the use of biological therapy for psoriasis does not significantly impact HIV viral load, CD4+ cell count, CD4+ proportion and rates of infection over the first 12 months of therapy.
Collapse
Affiliation(s)
- Jennifer Xu
- Faculty of Medicine, University of New South Wales, New South Wales, Sydney, Australia.,Department of Dermatology, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Kyra Gill
- Faculty of Medicine, University of New South Wales, New South Wales, Sydney, Australia.,Department of Dermatology, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Akshay Flora
- Faculty of Medicine, University of New South Wales, New South Wales, Sydney, Australia.,Department of Dermatology, Liverpool Hospital, Sydney, New South Wales, Australia.,Laboratory of Translational Cutaneous Medicine, Ingham Institute, Sydney, New South Wales, Australia
| | - Emily Kozera
- Faculty of Medicine, University of New South Wales, New South Wales, Sydney, Australia.,Department of Dermatology, Liverpool Hospital, Sydney, New South Wales, Australia
| | - John W Frew
- Faculty of Medicine, University of New South Wales, New South Wales, Sydney, Australia.,Department of Dermatology, Liverpool Hospital, Sydney, New South Wales, Australia.,Laboratory of Translational Cutaneous Medicine, Ingham Institute, Sydney, New South Wales, Australia
| |
Collapse
|
6
|
Gong J, Wu W, Qiu L, Wang X, Bao J, Wang J, Cheng L, Fu Z, Hu F. Interleukin-17A Inhibitor Secukinumab Treatment in HIV-Positive Psoriasis Patient: A Case Report. Clin Cosmet Investig Dermatol 2022; 15:2949-2956. [PMID: 36605452 PMCID: PMC9809383 DOI: 10.2147/ccid.s395348] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 12/23/2022] [Indexed: 01/01/2023]
Abstract
Psoriasis is an immune-mediated chronic inflammatory dermatosis influenced by hereditary and environmental factors. Human immunodeficiency virus (HIV) infection affects the immune system and exacerbates psoriatic lesions. We report the case of a 33-year-old male patient diagnosed with psoriasis vulgaris, psoriatic arthritis and HIV infection. Acitretin capsules, etanercept and high-active antiretroviral therapy (HAART) were effective. Two months after etanercept was discontinued, his condition worsened. After switching to secukinumab combined with HAART, the symptoms of psoriatic arthritis resolved rapidly after four weeks, with a Disease Activity Index for Psoriatic Arthritis score of 0. The time to achieve psoriasis area and severity index 40, 75, 90, and 100 were 2, 4, 8, and 29 weeks. The treatment was maintained for 1 year with no adverse reactions. Regarding the stable CD4+ T lymphocyte count and the viral load, administering anti-IL-17 monoclonal antibodies is an effective treatment option for psoriasis patients.
Collapse
Affiliation(s)
- Jian Gong
- Department of Integrated Traditional Chinese and Western Medicine of Dermatology, Dermatology Hospital of Jiangxi Province, Nanchang, Jiangxi, People’s Republic of China,Jiangxi Provincial Clinical Research Center for Skin Diseases, Nanchang, Jiangxi, People’s Republic of China
| | - Weiwei Wu
- Department of Plastic and Dermatological Surgery, The Fifth People’s Hospital of Hainan Province, Haikou, Hainan, People’s Republic of China
| | - Liguo Qiu
- Department of Integrated Traditional Chinese and Western Medicine of Dermatology, Dermatology Hospital of Jiangxi Province, Nanchang, Jiangxi, People’s Republic of China,Jiangxi Provincial Clinical Research Center for Skin Diseases, Nanchang, Jiangxi, People’s Republic of China
| | - Xi Wang
- Department of Integrated Traditional Chinese and Western Medicine of Dermatology, Dermatology Hospital of Jiangxi Province, Nanchang, Jiangxi, People’s Republic of China,Jiangxi Provincial Clinical Research Center for Skin Diseases, Nanchang, Jiangxi, People’s Republic of China
| | - Jianwei Bao
- Department of Integrated Traditional Chinese and Western Medicine of Dermatology, Dermatology Hospital of Jiangxi Province, Nanchang, Jiangxi, People’s Republic of China,Jiangxi Provincial Clinical Research Center for Skin Diseases, Nanchang, Jiangxi, People’s Republic of China
| | - Jinjing Wang
- Clinical School of Medicine, Jiangxi University of Traditional Chinese Medicine, Nanchang, Jiangxi, People’s Republic of China
| | - Lifang Cheng
- Department of Integrated Traditional Chinese and Western Medicine of Dermatology, Dermatology Hospital of Jiangxi Province, Nanchang, Jiangxi, People’s Republic of China,Jiangxi Provincial Clinical Research Center for Skin Diseases, Nanchang, Jiangxi, People’s Republic of China
| | - Zhiyuan Fu
- Department of Integrated Traditional Chinese and Western Medicine of Dermatology, Dermatology Hospital of Jiangxi Province, Nanchang, Jiangxi, People’s Republic of China,Department of Pharmacy, Dermatology Hospital of Jiangxi Province, Nanchang, Jiangxi, People’s Republic of China,Correspondence: Zhiyuan Fu, Department of Pharmacy, Dermatology Hospital of Jiangxi Province, Nanchang, Jiangxi, People’s Republic of China, Tel +86 13970827820, Fax +86-0791-85207512, Email
| | - Fengming Hu
- Department of Integrated Traditional Chinese and Western Medicine of Dermatology, Dermatology Hospital of Jiangxi Province, Nanchang, Jiangxi, People’s Republic of China,Jiangxi Provincial Clinical Research Center for Skin Diseases, Nanchang, Jiangxi, People’s Republic of China,Fengming Hu, Department of Integrated Traditional Chinese and Western Medicine of Dermatology, Dermatology Hospital of Jiangxi Province, Nanchang, Jiangxi, People’s Republic of China, Tel +86 13970935828, Fax +86-0791-85207512, Email
| |
Collapse
|
7
|
Impact and Tolerance of Immunosuppressive Treatments in Patients Living with HIV with Inflammatory or Autoimmune Diseases. Microorganisms 2022; 10:microorganisms10101891. [PMID: 36296168 PMCID: PMC9610421 DOI: 10.3390/microorganisms10101891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 09/09/2022] [Accepted: 09/16/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Patients living with HIV (PLWHIV) can develop autoimmune diseases (AD) needing immunosuppressive treatments (IST). This study aims to describe the impact of IST in PLWHIV. Methods: This was a multicentric retrospective observational study in six HIV referral centers on PLWHIV under IST for AD. Demographic factors, viral co-infections, immunovirological status before and under IST, infectious events, and their descriptions were collected and described focusing on infectious events, immunovirological variations, and IST effectiveness. Results: 9480 PLWHIV were screened for inclusion. Among them, 138 (1.5%) had a history of auto-immune disease, among which 32 (23%) received IST. There was mainly spondyloarthropathy (28%) and the most commonly used IST was methotrexate. The median follow-up under IST was 3.8 years (2.7; 5.9). There were 15 infectious events (0.5 events/individuals) concerning nine patients. At the last medical follow-up, 81% of these were in remission of their AD. Under IST, there was an increase in CD4 during follow-up (629 vs. 827 CD4/mm3, p = 0.04). No HIV virological failure was noted. Conclusions: This study supports a growing evidence base that IST can be used safely and effectively in PLWHIV with careful monitoring.
Collapse
|
8
|
Chen JW, Deng GS, Zhang WS, Zhang MY, Guan T, Xu Q. Case report: Safety and efficacy of adalimumab in treating difficult-to-treat rheumatoid arthritis in a human immunodeficiency virus-positive patient, one year follow-up. Front Immunol 2022; 13:942642. [PMID: 35990692 PMCID: PMC9382239 DOI: 10.3389/fimmu.2022.942642] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 07/14/2022] [Indexed: 11/13/2022] Open
Abstract
Rheumatoid arthritis (RA) is a joint-disabling inflammatory disease associated with the pathology of synovitis. Some patients with RA are difficult to treat, using disease-modifying anti-rheumatic drugs (DMARDs). Biology and targeted synthetic DMARDs (b/tsDMARDs) are options for patients with RA. Acquired immunodeficiency syndrome (AIDS) is an infectious disease caused by the human immunodeficiency virus (HIV). Adalimumab is an anti-tumor necrosis factor therapy commonly used in patients with RA. However, there are no reports or related data on patients with RA-HIV/AIDS treated with adalimumab are available. In this report, we described the first successful case of a 60-year-old HIV-positive woman with difficult-to-treat RA treated with ADA after being screened for hepatitis virus, latent tuberculosis (LTBI), and other infections. She contracted HIV from sexual exposure while on adalimumab therapy. As the patient was resistant to first-line DMARDs, she continued adalimumab along with the initiation of highly active antiretroviral therapy (HAART). The patient was treated with adalimumab therapy for a year; her CD4+ lymphocyte count was normal, HIV-1 RNA decreased, and no new infections were triggered. The patient achieved clinical remission of RA. In conclusion, adalimumab is a safe option for patients with RA-HIV and may slow the progression of HIV infection. Furthermore, HAART has the potential to reduce joint pain and fatigue in patients with difficult-to-treat RA.
Collapse
Affiliation(s)
- Jing-Wen Chen
- The First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Rheumatology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Guo-Shu Deng
- The First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Rheumatology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Wen-Shuang Zhang
- The First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Rheumatology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Ming-Ying Zhang
- The First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Rheumatology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Tong Guan
- The First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Rheumatology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- *Correspondence: Tong Guan, ; Qiang Xu,
| | - Qiang Xu
- The First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Rheumatology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- *Correspondence: Tong Guan, ; Qiang Xu,
| |
Collapse
|
9
|
Papp KA, Beecker J, Cooper C, Kirchhof MG, Pozniak AL, Rockstroh JK, Dutz JP, Gooderham MJ, Gniadecki R, Hong CH, Lynde CW, Maari C, Poulin Y, Vender RB, Walmsley SL. Use of Systemic Therapies for Treatment of Psoriasis in People Living with Controlled HIV: Inference-Based Guidance from a Multidisciplinary Expert Panel. Dermatol Ther (Heidelb) 2022; 12:1073-1089. [PMID: 35445963 PMCID: PMC9110627 DOI: 10.1007/s13555-022-00722-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 03/30/2022] [Indexed: 11/28/2022] Open
Abstract
Background People living with human immunodeficiency virus (PLHIV) have a similar prevalence of psoriasis as the general population, though incidence and severity correlate with HIV viral load. Adequately treating HIV early renders the infection a chronic medical condition and allows PLHIV with a suppressed viral load (PLHIV-s) to live normal lives. Despite this, safety concerns and a lack of high-level data have hindered the use of systemic psoriasis therapies in PLHIV-s. Objectives We aim to provide a structured framework that supports healthcare professionals and patients discussing the risks and benefits of systemic psoriasis therapy in PLHIV-s. Our goal was to address the primary question, are responses to systemic therapies for the treatment of psoriasis in PLHIV-s similar to those in the non-HIV population? Methods We implemented an inference-based approach relying on indirect evidence when direct clinical trial data were absent. In this instance, we reviewed indirect evidence supporting inferences on the status of immune function in PLHIV. Recommendations on systemic treatment for psoriasis in PLHIV were derived using an inferential heuristic. Results We identified seven indirect indicators of immune function informed by largely independent bodies of evidence: (1) functional assays, (2) vaccine response, (3) life expectancy, (4) psoriasis manifestations, (5) rate of infections, (6) rate of malignancies, and (7) organ transplant outcomes. Conclusions Drug-related benefits and risks when treating a patient with systemic psoriasis therapies are similar for non-HIV patients and PLHIV with a suppressed viral load and normalized CD4 counts. Prior to initiating psoriasis treatment in PLHIV, HIV replication should be addressed by an HIV specialist. Exercise additional caution for patients with a suppressed viral load and discordant CD4 responses on antiretroviral therapy. Supplementary Information The online version contains supplementary material available at 10.1007/s13555-022-00722-0. People living with human immunodeficiency virus (PLHIV) develop psoriasis as often as everyone else. We asked: what are effective and safe treatments when PLHIV need systemic therapy (pills or injections) for their psoriasis? HIV infection attacks the immune system. When HIV is not treated, the immune system declines. A less effective immune system makes it harder for the body to fight infections and certain cancers. Psoriasis is a skin condition caused by overactive immune cells. Effective psoriasis treatments reduce immune-cell activity. There are some concerns that treatments for psoriasis may not work and could worsen infections or cancers. To answer the question, we gathered 11 dermatologists and 4 HIV specialists. We reviewed the international scientific literature on PLHIV and psoriasis. The absence of direct evidence and volume of information to review made the process challenging. The end results were worthwhile. We concluded that people who are diagnosed early and take antiretroviral therapy to control their HIV infection (PLHIV-c) can live long, healthy lives. Accordingly, we determined that PLHIV-c can likely expect the same safety and efficacy for systemic psoriasis treatments as the general population. Treatment decisions should be made on a case-by-case basis through consultation with the patient and treating physician(s). Pillars of modern medicine are evidence-based care and collaborative decision-making. Too often, neither care provider nor patient are adequately informed. We have tried to fill one information gap for PLHIV and psoriasis. This process may help answer questions in other disease populations where direct evidence is scarce or absent.
Collapse
Affiliation(s)
- Kim A Papp
- Probity Medical Research Inc., Waterloo, ON, Canada. .,K Papp Clinical Research, Waterloo, ON, Canada.
| | - Jennifer Beecker
- Probity Medical Research Inc., Waterloo, ON, Canada.,University of Ottawa, Ottawa, ON, Canada.,Division of Dermatology, The Ottawa Hospital, Ottawa, ON, Canada.,Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Curtis Cooper
- University of Ottawa, Ottawa, ON, Canada.,Ottawa Hospital Research Institute, Ottawa, ON, Canada.,The Ottawa Hospital and Regional Hepatitis Program, Ottawa, ON, Canada
| | - Mark G Kirchhof
- University of Ottawa, Ottawa, ON, Canada.,Division of Dermatology, The Ottawa Hospital, Ottawa, ON, Canada
| | - Anton L Pozniak
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | | | - Jan P Dutz
- Skin Care Center, Vancouver, BC, Canada.,Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada.,BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Melinda J Gooderham
- Probity Medical Research Inc., Waterloo, ON, Canada.,SKiN Centre for Dermatology, Peterborough, ON, Canada
| | - Robert Gniadecki
- Division of Dermatology, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Chih-Ho Hong
- Probity Medical Research Inc., Waterloo, ON, Canada.,Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada.,Dr. Chih-Ho Hong Medical Inc., Surrey, BC, Canada
| | - Charles W Lynde
- Probity Medical Research Inc., Waterloo, ON, Canada.,Lynde Institute for Dermatology, Markham, ON, Canada
| | | | - Yves Poulin
- Centre de Recherche Dermatologique du Québec Métropolitain, Quebec, QC, Canada
| | - Ronald B Vender
- Dermatrials Research Inc., Hamilton, ON, Canada.,Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Sharon L Walmsley
- Toronto General Hospital Research Institute, Toronto, ON, Canada.,University of Toronto, Toronto, ON, Canada.,Department of Medicine, University Health Network, Toronto, ON, Canada
| |
Collapse
|
10
|
Hong JJ, Hadeler EK, Mosca ML, Brownstone ND, Bhutani T, Liao WJ. TNF-alpha inhibitors and ustekinumab for the treatment of psoriasis: therapeutic utility in the era of IL-17 and IL-23 inhibitors. JOURNAL OF PSORIASIS AND PSORIATIC ARTHRITIS 2022; 7:79-92. [PMID: 35757187 PMCID: PMC9229820 DOI: 10.1177/24755303211047479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Psoriasis is a chronic inflammatory condition for which eleven FDA-approved biologic therapies are approved. Over the past decade, studies have documented the higher efficacy of IL-17 and IL-23 inhibitors for the treatment of psoriasis compared to the TNF-alpha inhibitors and ustekinumab, an IL-12/23 inhibitor. Despite this, there remains an important role for the use of TNF-alpha inhibitors and ustekinumab in the treatment of psoriasis. Here, we review how considerations of infection and malignancy risk, patient demographics, treatment resistance, and co-morbidities may make certain TNF-alpha inhibitors or ustekinumab an excellent choice for therapy in particular patient subgroups.
Collapse
Affiliation(s)
- Julie J Hong
- University of California San Francisco, Department of Dermatology, Psoriasis and Skin Treatment Center
| | - Edward K Hadeler
- University of California San Francisco, Department of Dermatology, Psoriasis and Skin Treatment Center
| | - Megan L Mosca
- University of California San Francisco, Department of Dermatology, Psoriasis and Skin Treatment Center
| | - Nicholas D Brownstone
- University of California San Francisco, Department of Dermatology, Psoriasis and Skin Treatment Center
| | - Tina Bhutani
- University of California San Francisco, Department of Dermatology, Psoriasis and Skin Treatment Center
| | - Wilson J Liao
- University of California San Francisco, Department of Dermatology, Psoriasis and Skin Treatment Center
| |
Collapse
|
11
|
Chaiyabutr C, Jiamton S, Silpa-Archa N, Wongpraparut C, Wongdama S, Chularojanamontri L. Retrospective study of psoriasis in people living with HIV: Thailand's experience. J Dermatol 2022; 49:607-614. [PMID: 35293003 DOI: 10.1111/1346-8138.16352] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 02/09/2022] [Accepted: 02/22/2022] [Indexed: 11/30/2022]
Abstract
Psoriasis in people living with HIV (PLHIV) has been reported as having particular clinical characteristics. However, most of the source data was derived from descriptive studies in Europe and the USA. This study was conducted to compare the characteristics of psoriasis in PLHIV to general psoriasis patients. We retrospectively reviewed the records of 73 cases of psoriasis in PLHIV and of 232 general psoriasis patients who visited a psoriasis clinic in Bangkok, Thailand. Psoriasis in PLHIV predominated in males (78.1%), with an older age of onset, significantly lower rates of nail involvement and psoriatic arthritis, but higher rates of co-infectious diseases than for general psoriasis patients. A low nadir CD4 T-cell count (<100 cells/μl) and CD4 T-cell count at psoriasis diagnosis were associated with a high body surface area (BSA) involvement. The mean BSA involvement in PLHIV was 24. Although 64.4% (47/73) of the PLHIV had moderate-to-high psoriasis severity, 29.8% of those (14/47) only received topical treatment. Acitretin was the most common drug used. Other therapies were rarely used, and no biologics were administered. In conclusion, psoriasis in PLHIV has several clinical features that differ from general psoriasis. PLHIV tend to receive substandard care for psoriasis, even in upper-middle-income countries.
Collapse
Affiliation(s)
- Chayada Chaiyabutr
- Department of Dermatology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sukhum Jiamton
- Department of Dermatology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Narumol Silpa-Archa
- Department of Dermatology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Chanisada Wongpraparut
- Department of Dermatology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Supisara Wongdama
- Department of Dermatology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Leena Chularojanamontri
- Department of Dermatology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| |
Collapse
|
12
|
Kidron A, Nguyen H, Nguyen H. Triumvirate Presentation and Treatment of Psoriasis in the Setting of HIV and Treponema pallidum Infection. Cureus 2022; 14:e22129. [PMID: 35308705 PMCID: PMC8920797 DOI: 10.7759/cureus.22129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 02/10/2022] [Indexed: 11/08/2022] Open
Abstract
Psoriasis is an autoimmune condition in which the immune system attacks healthy skin cells, causing the accelerated formation of new skin characterized by scaly patches or plaques. These lesions are formed due to the formation of new skin underneath dead skin that has yet to be shed. Although the cause of psoriasis is not completely understood, it has been associated with infections that may trigger or exacerbate the condition. Syphilis, a highly infectious sexually transmitted disease, may trigger a psoriasis outbreak; because syphilis is known as “the great imitator”, it can present as many other chronic dermatoses and therefore often makes it very difficult to diagnose. Here, we describe a case of a 17-year-old Vietnamese male from Dong Nai Province who was initially diagnosed with psoriasis and later diagnosed with syphilis and HIV infection upon further investigation and testing.
Collapse
|
13
|
Psoriasis in Patients Attending a Large HIV Clinic in Trinidad. Med Sci (Basel) 2022; 10:medsci10010009. [PMID: 35225942 PMCID: PMC8883907 DOI: 10.3390/medsci10010009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/25/2022] [Accepted: 01/27/2022] [Indexed: 11/29/2022] Open
Abstract
The data on psoriasis in persons infected with HIV in the Caribbean is sparse. A cross-sectional study was conducted on patients attending the HIV Clinic diagnosed with psoriasis where sociodemographic data and data on the pattern of psoriasis were collected and analysed using SPSS version 25. Over the period April 2002–December 2018, 37 persons attending the HIV clinic were diagnosed with psoriasis, age range at psoriasis diagnosis 13–70 years, mean age at diagnosis 37.7 years and 32 (86.5%) were male. Over the study period, 8916 patients were registered at the HIV Clinic and the prevalence of psoriasis among these patients was 0.42% which is less than the reported prevalence of psoriasis among persons infected with HIV of 2–3% in other studies. Severe/generalised psoriasis was present in 7 (18.9%) patients while 30 (81.1%) patients had mild/moderate psoriasis. A family history of psoriasis was present in 1 (2.7%) patient, psoriatic arthritis was present in 2 (5.4%) patients and 31 (83.8%) patients reported that there was improvement in the psoriasis with the topical therapy provided. The study makes an original contribution in the determination of the prevalence and pattern of psoriasis among patients attending a HIV Clinic in Trinidad.
Collapse
|
14
|
Babkova MI, Arshinsky MI, Frolova ZV, Chudina OA, Mitrofanova JS, Batalova SK. Experience of using ustekinumab in the treatment of a patient with HIV-associated psoriasis and anogenital warts. VESTNIK DERMATOLOGII I VENEROLOGII 2021. [DOI: 10.25208/vdv1150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
The article presents an analysis of the literature of patients with HIV infection suffering from psoriasis. The clinical picture, laboratory data, and treatment of a patient suffering from psoriasis, psoriatic arthritis, anogenital venereal warts associated with HIV infection are described. Against the background of the use of an IL 12.23 inhibitor, regression of anogenital warts, resolution of psoriatic rashes, and relief of articular syndrome were noted.
Collapse
|
15
|
Papp KA, Gooderham MJ, Lynde CW, Poulin Y, Beecker J, Dutz JP, Hong CH, Gniadecki R, Kirchhof MG, Maari C, Vender RB. Practical and Relevant Guidelines for the Management of Psoriasis: An Inference-Based Methodology. Dermatol Ther (Heidelb) 2021; 12:253-265. [PMID: 34939178 PMCID: PMC8776962 DOI: 10.1007/s13555-021-00642-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 11/01/2021] [Indexed: 01/02/2023] Open
Abstract
Introduction Psoriasis (Pso) is a common, immune-mediated, chronic-relapsing, inflammatory skin disease. While a great deal is known about Pso and its treatment, there remain several treatment scenarios unaddressed by clinical studies. To be effective, treatment for Pso must alter the activity of one or more immunological pathways important in the pathogenesis of the disease. While the benefit of blocking these pathways may be apparent, there remain uncertainties regarding safety, such as infections, malignancies, and the potential for off-target effects. Existing guidelines and treatment recommendations rely primarily on clinical trial or observational data, none of which adequately address specific clinical challenges. This document describes a methodological framework for generating practical and clinically relevant guidance for situations where direct evidence is rare or absent. Guidelines implementing this framework are currently ongoing. Methods We develop a knowledge synthesis approach to guideline development, utilizing clinical trial data where available, and a formalized inferential decision-making process that considers indirect data coupled with structured expert opinion and analysis. This approach is best suited for situations where direct, high-level evidence is lacking. Support for each resultant recommendation is expressed as a quantified assessment of confidence. Results The topics to be addressed by this set of guidelines are ranked by clinicians and patients as areas of concern, with an emphasis on topics where high-level evidence may have limited availability. Conclusion Through this novel approach, we will derive practical, informative recommendations using the best evidence available in combination with structured expert opinion to guide best practices in complex, real-world settings. Supplementary file2 (MP4 98653 kb)
Supplementary Information The online version contains supplementary material available at 10.1007/s13555-021-00642-5. Clinical guidelines aim to assist doctors in managing their patients’ medical conditions. A limitation of current guidelines is that they are frequently based on randomized clinical research trials—often considered the gold standard in medical research. Clinical trials are designed to estimate the safety and effectiveness of treatment. Outside of clinical trials, doctors encounter a range of patient cases excluded from clinical trials. Our group aims to create guidelines for those clinical scenarios not adequately addressed by clinical trials. Examples include patients excluded from clinical trials, the elderly, patients with human immunodeficiency virus (HIV), and pregnant or breastfeeding women. When clinical trial data is limited, doctors must make decisions nonetheless. In certain clinical situations they are left to their own resources to consult with experts, review the data, and make inferences based on the limited data available. Instead of concluding that there is no data, the topic of interest can be broken down into components that are answerable by different types of research studies. This inference-based approach uses expert opinion and indirect evidence to support an inference-based position on topics where direct clinical data is sparse or insufficient to answer the question. This approach can be used as a complement to clinical trial data informing disease management guidelines.
Collapse
Affiliation(s)
- Kim A Papp
- Probity Medical Research Inc., Waterloo, ON, Canada. .,K Papp Clinical Research, Waterloo, ON, Canada.
| | - Melinda J Gooderham
- Probity Medical Research Inc., Waterloo, ON, Canada.,SKiN Centre for Dermatology, Peterborough, ON, Canada
| | - Charles W Lynde
- Probity Medical Research Inc., Waterloo, ON, Canada.,Lynde Institute for Dermatology, Markham, ON, Canada
| | - Yves Poulin
- Centre de Recherche Dermatologique du Québec Métropolitain, Quebec, QC, Canada
| | - Jennifer Beecker
- Probity Medical Research Inc., Waterloo, ON, Canada.,University of Ottawa, Ottawa, ON, Canada.,Division of Dermatology, The Ottawa Hospital, Ottawa, ON, Canada.,Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Jan P Dutz
- Skin Care Center, Vancouver, BC, Canada.,Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada.,Skin Science, BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Chih-Ho Hong
- Probity Medical Research Inc., Waterloo, ON, Canada.,Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada.,Dr. Chih-ho Hong Medical Inc., Surrey, BC, Canada
| | - Robert Gniadecki
- Division of Dermatology, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Mark G Kirchhof
- University of Ottawa, Ottawa, ON, Canada.,Division of Dermatology, The Ottawa Hospital, Ottawa, ON, Canada
| | | | - Ronald B Vender
- Dermatrials Research Inc., Hamilton, ON, Canada.,Department of Medicine, McMaster University, Hamilton, ON, Canada
| |
Collapse
|
16
|
Bressler MY, Pathak N, Rotblat D, Tamez R. Acute HIV Infection Presenting With Diffuse Plaque Psoriasis Treated With Highly Active Antiretroviral Therapy. Cureus 2021; 13:e19680. [PMID: 34976468 PMCID: PMC8681926 DOI: 10.7759/cureus.19680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2021] [Indexed: 12/03/2022] Open
Abstract
Cutaneous diseases such as psoriasis are often the first disease manifestations in HIV+ patients, with greater severity corresponding to a weaker immune system. Despite its prevalence, literature and placebo-controlled studies on the recognition of HIV as a cause of psoriasis are lacking, causing challenges to arise in its treatment. In this article, we illustrate a case of an HIV+ patient whose psoriasis drastically improved after the initiation of highly active antiretroviral therapy (HAART) consisting of bictegravir, emtricitabine, and tenofovir alafenamide. While it is unclear which combination of antiretrovirals is optimal for controlling psoriasis in HIV+ patients, prompt initiation of HAART can significantly improve immune status and psoriasis in HIV+ patients.
Collapse
|
17
|
Yan D, Gudjonsson JE, Le S, Maverakis E, Plazyo O, Ritchlin C, Scher JU, Singh R, Ward NL, Bell S, Liao W. New Frontiers in Psoriatic Disease Research, Part I: Genetics, Environmental Triggers, Immunology, Pathophysiology, and Precision Medicine. J Invest Dermatol 2021; 141:2112-2122.e3. [PMID: 34303522 PMCID: PMC8384663 DOI: 10.1016/j.jid.2021.02.764] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 02/23/2021] [Accepted: 02/24/2021] [Indexed: 02/07/2023]
Abstract
Psoriasis is a chronic inflammatory condition characterized by systemic immune dysregulation. Over the past several years, advances in genetics, microbiology, immunology, and mouse models have revealed the complex interplay between the heritable and microenvironmental factors that drive the development of psoriatic inflammation. In the first of this two-part review series, the authors will discuss the newest insights into the pathogenesis of psoriatic disease and highlight how the evolution of these scientific fields has paved the way for a more personalized approach to psoriatic disease treatment.
Collapse
Affiliation(s)
- Di Yan
- Ronald O. Perelman Department of Dermatology, NYU Langone Health, New York, New York, USA
| | | | - Stephanie Le
- Department of Dermatology, University of California, Davis, Sacramento, California, USA
| | - Emanual Maverakis
- Department of Dermatology, University of California, Davis, Sacramento, California, USA
| | - Olesya Plazyo
- Department of Dermatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Christopher Ritchlin
- Center for Musculoskeletal Research, Division of Allergy, Immunology and Rheumatology, University of Rochester School of Medicine & Dentistry, Rochester, New York, USA
| | - Jose U Scher
- Department of Medicine, NYU Grossman School of Medicine, NYU Langone Health, New York, New York, USA
| | - Roopesh Singh
- Department of Nutrition, School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Nicole L Ward
- Department of Nutrition, School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA; Department of Dermatology, School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Stacie Bell
- National Psoriasis Foundation, Portland, Oregon, USA
| | - Wilson Liao
- UCSF Department of Dermatology, University of California San Francisco, San Francisco, California, USA.
| |
Collapse
|
18
|
Rajagopalan M, Dogra S, Saraswat A, Varma S, Banodkar P. The Use of Apremilast in Psoriasis: An Indian Perspective on Real-World Scenarios. Psoriasis (Auckl) 2021; 11:109-122. [PMID: 34430450 PMCID: PMC8375310 DOI: 10.2147/ptt.s320810] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 06/20/2021] [Indexed: 12/27/2022] Open
Abstract
Apremilast, an oral phosphodiesterase-4 inhibitor, is approved for use in the management of psoriasis and psoriatic arthritis. Although its efficacy and safety have been well established in clinical studies, in real-world settings, different practice scenarios have been reported. This review paper serves to evaluate clinical real-world scenarios and aspects of treatment for which the information in the literature was considered to be lacking or controversial. Following a literature review, a panel of five dermatologists with expertise in psoriasis considered five scenarios; namely, the positioning of apremilast in psoriasis, its use in difficult-to-treat areas, special conditions and populations, safety, dose titration and dose in maintenance therapy. These were then assessed with psoriasis experts in India using a web-based questionnaire. A total of 28 questions were discussed regarding these scenarios. According to the responses, apremilast is effective in stable mild to moderate psoriasis as monotherapy and in severe psoriasis in combination. Also, a positive response was received with regard to its effectiveness in difficult locations such as the scalp, palms and soles. To reduce adverse effects, prolonged titration therapy over 4 weeks is required and lower doses can be prescribed to maintain remission. Apremilast therapy should be continued for a minimum of 8 weeks once initiated to achieve the desired results, and the total duration of therapy should be about 24 weeks for better efficacy. It is also effective in many other cases, such as obese patients, patients with hepatitis B or C and HIV, or patients on polypharmacy. It was also reported that apremilast requires less prescreening and monitoring than other conventional and biologic systemic therapies. Overall, apremilast is an attractive option for the individualized treatment of psoriasis owing to its favorable safety profile, its ease of oral administration without the need for screening or ongoing laboratory monitoring, and its positive impact on symptoms and lesions in difficult-to-treat areas.
Collapse
Affiliation(s)
- Murlidhar Rajagopalan
- Department of Dermatology, Apollo Hospitals, Chennai, Tamilnadu, India
- Correspondence: Murlidhar Rajagopalan Dermatology, Apollo Hospital, No 21, Greams Lane, Off Greams Road, Chennai, 600006, Tamil Nadu, IndiaTel +91 9840045500 Email
| | - Sunil Dogra
- Department of Dermatology, Venereology & Leprology, PGIMER, Chandigarh, India
| | - Abir Saraswat
- Indushree Skin Clinic, Lucknow, Uttar Pradesh, India
| | - Sachin Varma
- Skinvita Clinic Kolkata, Department of Dermatology, Apollo Hospital, Kolkata, West Bengal, India
| | - Pravin Banodkar
- Skin Crest Clinic, Mumbai, Department of Dermatology, Saifee Hospital, Breach Candy Hospital, and St. Elizabeth’s Hospital, Mumbai, Maharashtra, India
| |
Collapse
|
19
|
Bui H, Skiba PN, Breskin A, Sayed C. Hidradenitis suppurativa among patients with HIV: investigating patient and disease characteristics and misdiagnosis. Br J Dermatol 2021; 185:1070-1072. [PMID: 34155629 DOI: 10.1111/bjd.20591] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 06/13/2021] [Accepted: 06/21/2021] [Indexed: 01/04/2023]
Affiliation(s)
- H Bui
- University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - P N Skiba
- State University of New York Downstate Medical Center, Brooklyn, NY, USA
| | - A Breskin
- NoviSci Inc and Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - C Sayed
- University of North Carolina School of Medicine, Chapel Hill, NC, USA
| |
Collapse
|
20
|
Kucharzik T, Ellul P, Greuter T, Rahier JF, Verstockt B, Abreu C, Albuquerque A, Allocca M, Esteve M, Farraye FA, Gordon H, Karmiris K, Kopylov U, Kirchgesner J, MacMahon E, Magro F, Maaser C, de Ridder L, Taxonera C, Toruner M, Tremblay L, Scharl M, Viget N, Zabana Y, Vavricka S. ECCO Guidelines on the Prevention, Diagnosis, and Management of Infections in Inflammatory Bowel Disease. J Crohns Colitis 2021; 15:879-913. [PMID: 33730753 DOI: 10.1093/ecco-jcc/jjab052] [Citation(s) in RCA: 178] [Impact Index Per Article: 59.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- T Kucharzik
- Department of Gastroenterology, Klinikum Lüneburg, University of Hamburg, Lüneburg, Germany
| | - P Ellul
- Department of Medicine, Division of Gastroenterology, Mater Dei Hospital, Msida, Malta
| | - T Greuter
- University Hospital Zürich, Department of Gastroenterology and Hepatology, Zürich, Switzerland, and Division of Gastroenterology and Hepatology, Centre Hospitalier Universitaire Vaudois CHUV, University Hospital Lausanne, Lausanne, Switzerland
| | - J F Rahier
- Department of Gastroenterology and Hepatology, CHU UCL Namur, Yvoir, Belgium
| | - B Verstockt
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium, and Department of Chronic Diseases, Metabolism and Ageing, TARGID-IBD, KU Leuven, Leuven, Belgium
| | - C Abreu
- Infectious Diseases Service, Centro Hospitalar Universitário São João, Porto, Portugal.,Instituto de Inovação e Investigação em Saúde [I3s], Faculty of Medicine, Department of Medicine, University of Porto, Portugal
| | - A Albuquerque
- Gastroenterology Department, St James University Hospital, Leeds, UK
| | - M Allocca
- Humanitas Clinical and Research Center - IRCCS -, Rozzano [Mi], Italy.,Humanitas University, Department of Biomedical Sciences, Milan, Italy
| | - M Esteve
- Hospital Universitari Mútua Terrassa, Digestive Diseases Department, Terrassa, Catalonia, and Centro de Investigación Biomédica en red de Enfermedades Hepáticas y Digestivas CIBERehd, Madrid, Spain
| | - F A Farraye
- Inflammatory Bowel Disease Center, Department of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL, USA
| | - H Gordon
- Department of Gastroenterology, Barts Health NHS Trust, Royal London Hospital, London, UK
| | - K Karmiris
- Department of Gastroenterology, Venizeleio General Hospital, Heraklion, Greece
| | - U Kopylov
- Department of Gastroenterology, Sheba Medical Center, Ramat Gan, Israel, and Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - J Kirchgesner
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpital Saint-Antoine, Department of Gastroenterology, Paris, France
| | - E MacMahon
- Department of Infectious Diseases, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - F Magro
- Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal.,Institute of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Portugal
| | - C Maaser
- Outpatient Department of Gastroenterology, Department of Geriatrics, Klinikum Lüneburg, University of Hamburg, Lüneburg, Germany
| | - L de Ridder
- Department of Paediatric Gastroenterology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - C Taxonera
- IBD Unit, Department of Gastroenterology, Hospital Clínico San Carlos and Instituto de Investigación del Hospital Clínico San Carlos [IdISSC], Madrid, Spain
| | - M Toruner
- Ankara University School of Medicine, Department of Gastroenterology, Ankara, Turkey
| | - L Tremblay
- Centre Hospitalier de l'Université de Montréal [CHUM] Pharmacy Department and Faculty of Pharmacy, Université de Montréal, Montréal, QC, Canada
| | - M Scharl
- University Hospital Zürich, Department of Gastroenterology and Hepatology, Zürich, Switzerland
| | - N Viget
- Department of Infectious Diseases, Tourcoing Hospital, Tourcoing, France
| | - Y Zabana
- Hospital Universitari Mútua Terrassa, Digestive Diseases Department, Terrassa, Catalonia, and Centro de Investigación Biomédica en red de Enfermedades Hepáticas y Digestivas CIBERehd, Madrid, Spain
| | - S Vavricka
- University Hospital Zürich, Department of Gastroenterology and Hepatology, Zürich, Switzerland
| |
Collapse
|
21
|
Arisi M, Gelmetti A, Focà E, Rossi M, Rovati C, Calzavara-Pinton P, Venturini M. UVA1 phototherapy as a treatment option for plaque psoriasis in HIV-positive patients. PHOTODERMATOLOGY, PHOTOIMMUNOLOGY & PHOTOMEDICINE 2020; 36:478-480. [PMID: 32473061 DOI: 10.1111/phpp.12581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 05/01/2020] [Accepted: 05/24/2020] [Indexed: 06/11/2023]
Affiliation(s)
- Mariachiara Arisi
- Dermatology Unit, ASST Spedali Civili, University of Brescia, Brescia, Italy
| | - Alessandra Gelmetti
- Dermatology Unit, ASST Spedali Civili, University of Brescia, Brescia, Italy
| | - Emanuele Focà
- Department of Infectious and Tropical Diseases, ASST Spedali Civili, University of Brescia, Brescia, Italy
| | - Mariateresa Rossi
- Dermatology Unit, ASST Spedali Civili, University of Brescia, Brescia, Italy
| | - Chiara Rovati
- Dermatology Unit, ASST Spedali Civili, University of Brescia, Brescia, Italy
| | | | - Marina Venturini
- Dermatology Unit, ASST Spedali Civili, University of Brescia, Brescia, Italy
| |
Collapse
|
22
|
Management of psoriatic patients in biologic treatment associated with infectious comorbidities. Postepy Dermatol Alergol 2020; 37:417-421. [PMID: 32792886 PMCID: PMC7394172 DOI: 10.5114/ada.2020.96155] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 11/17/2018] [Indexed: 12/28/2022] Open
Abstract
Introduction Psoriasis is a chronic inflammatory disease affecting about 2% of population, involving both acquired and innate immunity. Psoriasis affects mainly skin, presenting multiple co-morbidities; among them infective ones. Re-activation of tuberculosis or viral hepatitis (HBV and HCV) still represents a therapeutic challenge in patients receiving treatment with biological drugs, as well as HIV infection. For this reason, a multidisciplinary approach with global treatment resulting from active collaboration of different specialists is highly recommended. Aim To investigate the most common infective diseases as co-morbidities associated with psoriasis and to provide algorithms for screening, follow-up and therapeutic management in psoriatic patients. Material and methods We examined the main infectious comorbidities that can affect moderate to severe psoriatic patients, influencing the therapeutic choice as during the biological treatment both viral and tuberculosis re-activation may occur. We have therefore evaluated the main diseases (TB, Hepatitis B and C, HIV) and the monitoring of patients during treatment with biological agents. Results Regular monitoring of psoriatic patients is recommended during long-term treatment with biological drugs in order to identify cases of re-activation of the latent infective agent or de novo acquired infection. Conclusions Here we report the state of art regarding management of psoriatic patients with these co-morbidities suggesting a specific screening and management for infectious diseases in patients with moderate to severe plaque psoriasis.
Collapse
|
23
|
Wu JJ, Merola JF, Feldman SR, Menter A, Lebwohl M. Treatment of Psoriasis with Secukinumab in Challenging Patient Scenarios: A Review of the Available Evidence. Dermatol Ther (Heidelb) 2020; 10:351-364. [PMID: 32242325 PMCID: PMC7211772 DOI: 10.1007/s13555-020-00373-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Indexed: 01/06/2023] Open
Abstract
Psoriasis (PsO) is a common, systemic, chronic, inflammatory disease characterized by key clinical symptoms, including itching, pain, and scaling. PsO is associated with a high prevalence of comorbidities, including other autoimmune diseases and malignancies. Furthermore, special populations, such as pregnant, pediatric, and elderly patients, and those with erythrodermic PsO, are challenging to treat and require tightly monitored disease and treatment management. Because certain populations have demographic or clinical characteristics that can affect the presentation of PsO and complicate treatment responses, these patient populations are largely excluded from clinical trials; therefore, most clinical evidence for the treatment of these patients is derived from case reports and series. Secukinumab, a fully human monoclonal interleukin-17A antibody, has been shown in several clinical trials to be effective and safe for the treatment of PsO; however, these studies offer only limited data on the use of secukinumab in patients with chronic illnesses or in special populations. This review explores the use of secukinumab for PsO in special populations, including pregnant women, children, elderly people, patients with erythrodermic PsO, and those with chronic illnesses, including latent tuberculosis, hepatitis B and C, HIV, multiple sclerosis, and malignancies.
Collapse
Affiliation(s)
- Jashin J Wu
- Dermatology Research and Education Foundation, Irvine, CA, USA.
| | - Joseph F Merola
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Steven R Feldman
- Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Alan Menter
- Baylor Scott & White Health, Dallas, TX, USA
| | | |
Collapse
|
24
|
Bedoui Y, Guillot X, Sélambarom J, Guiraud P, Giry C, Jaffar-Bandjee MC, Ralandison S, Gasque P. Methotrexate an Old Drug with New Tricks. Int J Mol Sci 2019; 20:E5023. [PMID: 31658782 PMCID: PMC6834162 DOI: 10.3390/ijms20205023] [Citation(s) in RCA: 205] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 09/16/2019] [Accepted: 09/30/2019] [Indexed: 12/16/2022] Open
Abstract
Methotrexate (MTX) is the first line drug for the treatment of a number of rheumatic and non-rheumatic disorders. It is currently used as an anchor disease, modifying anti-rheumatic drug in the treatment of rheumatoid arthritis (RA). Despite the development of numerous new targeted therapies, MTX remains the backbone of RA therapy due to its potent efficacy and tolerability. There has been also a growing interest in the use of MTX in the treatment of chronic viral mediated arthritis. Many viruses-including old world alphaviruses, Parvovirus B19, hepatitis B/C virus, and human immunodeficiency virus-have been associated with arthritogenic diseases and reminiscent of RA. MTX may provide benefits although with the potential risk of attenuating patients' immune surveillance capacities. In this review, we describe the emerging mechanisms of action of MTX as an anti-inflammatory drug and complementing its well-established immunomodulatory activity. The mechanisms involve adenosine signaling modulation, alteration of cytokine networks, generation of reactive oxygen species and HMGB1 alarmin suppression. We also provide a comprehensive understanding of the mechanisms of MTX toxic effects. Lastly, we discussed the efficacy, as well as the safety, of MTX used in the management of viral-related rheumatic syndromes.
Collapse
Affiliation(s)
- Yosra Bedoui
- Unité Mixte de Recherche Processus Infectieux en Milieu Insulaire Tropical (PIMIT), INSERM U1187, CNRS 9192, IRD 249, Université de La Réunion-Plateforme Technologique CYROI-2, rue Maxime Rivière, 97490 Sainte-Clotilde, France.
| | - Xavier Guillot
- Service de Rhumatologie, CHU La Réunion site Félix Guyon, Allée des Topazes, CS11021, 97400 Saint Denis de La Réunion, France.
| | - Jimmy Sélambarom
- Unité Mixte de Recherche Processus Infectieux en Milieu Insulaire Tropical (PIMIT), INSERM U1187, CNRS 9192, IRD 249, Université de La Réunion-Plateforme Technologique CYROI-2, rue Maxime Rivière, 97490 Sainte-Clotilde, France.
| | - Pascale Guiraud
- Unité Mixte de Recherche Processus Infectieux en Milieu Insulaire Tropical (PIMIT), INSERM U1187, CNRS 9192, IRD 249, Université de La Réunion-Plateforme Technologique CYROI-2, rue Maxime Rivière, 97490 Sainte-Clotilde, France.
| | - Claude Giry
- Laboratoire de biologie, CNR associé des arbovirus, CHU La Réunion site Félix Guyon, Allée des Topazes, CS11021, 97400 Saint Denis de La Réunion, France.
| | - Marie Christine Jaffar-Bandjee
- Laboratoire de biologie, CNR associé des arbovirus, CHU La Réunion site Félix Guyon, Allée des Topazes, CS11021, 97400 Saint Denis de La Réunion, France.
| | - Stéphane Ralandison
- Service de Rhumatologie-Médecine Interne, CHU Morafeno, Route d'Ivoloina 501, Toamasina, Madagascar.
| | - Philippe Gasque
- Unité Mixte de Recherche Processus Infectieux en Milieu Insulaire Tropical (PIMIT), INSERM U1187, CNRS 9192, IRD 249, Université de La Réunion-Plateforme Technologique CYROI-2, rue Maxime Rivière, 97490 Sainte-Clotilde, France.
- Pôle de Biologie, secteur Laboratoire d'Immunologie Clinique et Expérimentale de la zone de l'Océan Indien (LICE-OI), CHU La Réunion site Félix Guyon, Allée des Topazes, CS11021, 97400 Saint Denis de La Réunion, France.
| |
Collapse
|
25
|
Abstract
HIV has long been associated with a number of inflammatory, infectious, and neoplastic skin conditions. In the era of anti-retroviral therapy, we have discovered even more about the relationship between skin disease and chronic immunosuppression. In particular, clinicians still face the propensity of persons living with HIV to develop difficult-to-control viral infections, chronic skin inflammation, and pruritus and—particularly as patients age—various types of skin cancers. Here, we summarize recent updates in the field of HIV dermatology and make recommendations to providers caring for these patients.
Collapse
Affiliation(s)
- Sarah J Coates
- Department of Dermatology, University of California San Francisco, 1701 Divisadero Street, San Francisco, CA, 94115, USA
| | - Kieron S Leslie
- Department of Dermatology, University of California San Francisco, 1701 Divisadero Street, San Francisco, CA, 94115, USA
| |
Collapse
|
26
|
Chelidze K, Thomas C, Chang AY, Freeman EE. HIV-Related Skin Disease in the Era of Antiretroviral Therapy: Recognition and Management. Am J Clin Dermatol 2019; 20:423-442. [PMID: 30806959 PMCID: PMC6581453 DOI: 10.1007/s40257-019-00422-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Antiretroviral therapy (ART) has revolutionized the treatment and prognosis of people living with HIV (PLHIV). With increased survival and improved overall health, PLHIV are experiencing dermatologic issues both specific to HIV and common to the general population. In this new era of ART, it is crucial for dermatologists to have a strong understanding of the broad range of cutaneous disease and treatment options in this unique population. In this review, we outline the most common skin diseases in PLHIV, including HIV-associated malignancies, inflammatory conditions, and infections, and focus on the role of ART in altering epidemiology, clinical features, diagnosis, and treatment of cutaneous conditions.
Collapse
Affiliation(s)
- Khatiya Chelidze
- Weill Cornell Medical College, Massachusetts General Hospital, 1300 York Avenue, New York, NY, 10021, USA
| | - Cristina Thomas
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Bartlett Hall 6R, Boston, MA, 02114, USA
| | - Aileen Yenting Chang
- Department of Dermatology, University of California, San Francisco, 505 Paranassus Avenue, San Francisco, CA, 94143, USA
| | - Esther Ellen Freeman
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Bartlett Hall 6R, Boston, MA, 02114, USA.
- Medical Practice Evaluation Center, Mongan Institute, Massachusetts General Hospital, 100 Cambridge Street, 16th Floor, Boston, MA, 02114, USA.
| |
Collapse
|
27
|
Zarbafian M, Cote B, Richer V. Treatment of moderate to severe psoriasis with apremilast over 2 years in the context of long-term treated HIV infection: A case report. SAGE Open Med Case Rep 2019; 7:2050313X19845193. [PMID: 31105941 PMCID: PMC6503584 DOI: 10.1177/2050313x19845193] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Treatment of moderate-to-severe psoriasis in patients with HIV infection is a
clinical challenge. We present the case of a patient with a longstanding history
of well-controlled HIV. He had failed topical management, and his
hypertriglyceridemia made use of acitretin potentially unsafe. He was unable to
regularly attend a phototherapy unit. Physical examination revealed 12% total
body surface area involvement with a Psoriasis Area Severity Index (PASI) of
10.2. His Dermatology Quality of Life Index (DLQI) was 20. After 3 months of
apremilast treatment, his PASI decreased to 4.1. After 7 months, his PASI
decreased to 2.7 and his DLQI to 1. Two years later, his PASI score was 2.4,
with a stable CD4 count of 1200 cells/mm3 and an undetectable viral
load. There were no serious opportunistic infections or laboratory
abnormalities. To our knowledge, this represents the second reported case of
psoriasis treatment with apremilast in a patient with HIV.
Collapse
Affiliation(s)
- Misha Zarbafian
- Department of Dermatology and Skin Science, The University of British Columbia, Vancouver, BC, Canada
| | - Benoit Cote
- Division of Dermatology, Faculty of Medicine, Universite de Montreal, Montreal, QC, Canada
| | - Vincent Richer
- Department of Dermatology and Skin Science, The University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
28
|
Plachouri KM, Georgiou S. Challenges in the treatment of psoriasis with biologics: vaccination, history of malignancy, human immunodeficiency virus (HIV) infection, and pediatric psoriasis. Int J Dermatol 2019; 58:1008-1013. [PMID: 30891751 DOI: 10.1111/ijd.14436] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 01/23/2019] [Accepted: 02/28/2019] [Indexed: 12/25/2022]
Abstract
Biologics are potent immunomodulatory drugs, whose application in the treatment of psoriasis has shown extremely good therapeutic results and a satisfactory safety profile. The administration of these agents in special cases, such as in patients with HIV infection, previous malignancy, unclear vaccination status as well as children, can be challenging. This report is an updated systematic review of the use of biologics in the above-mentioned groups. Articles derived from the databases PubMed, EMBASE, and SCOPUS, and published between 1989 and 2018, were analyzed for this study. The existing evidence is not in all cases sufficient in order to provide adequate insight on the management of these complex situations. The aim of this report is to present a summarized update on the knowledge of this special topic so far and to draw into attention the need to conduct more systematic studies so as to clarify the best therapeutic strategies for these special patient groups when it comes to the use of biologics.
Collapse
Affiliation(s)
| | - Sophia Georgiou
- Dermatology Department, University of Patras, Patras, Greece
| |
Collapse
|
29
|
Guignant M, Mahé E, Duval-Modeste AB, Vermersch-Langlin A. [Psoriasis and HIV infection, what do French dermatologists do?]. Ann Dermatol Venereol 2019; 146:265-272. [PMID: 30833038 DOI: 10.1016/j.annder.2019.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 11/14/2018] [Accepted: 01/07/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND The prevalence of psoriasis among patients presenting human immunodeficiency virus (HIV)infection is the same as in the general population, but the disease is more severe and refractory, and management is more complex. The aim of this survey was to assess the practices of French dermatologists concerning both screening for HIV in psoriasis patients and therapeutic management and follow-up of psoriasis patients with HIV. PATIENTS AND METHODS An anonymous national survey of practices was conducted by means of a questionnaire emailed to dermatologists in hospital in private practice in France between March and June 2017. RESULTS The questionnaire was completed by 262 dermatologists. They indicated that they carried out screening for HIV in psoriasis patients presenting risk factors (79.4%), prior to biotherapy (63.4%) or different systemic treatments other than retinoids (53.1%), if the psoriasis was severe (45.8%), or in the event of worsening (37.8%). 28.7% of practitioners surveyed were in fact treating patients with psoriasis and HIV, with a mean 3.1 patients being followed up. All practitioners prescribe systemic treatment, other than cyclosporine, but they frequently consult an infectious disease specialist before prescribing these therapies. The most widely used biotherapy was etanercept (65.5% of practitioners). More intensive laboratory follow-up was conducted for these patients in 72.1% of cases. CONCLUSION French dermatologists do not perform routine screening for HIV in psoriasis patients. However, where infection has been identified, their practices are modified accordingly. Therapeutic choices are consistent with the French recommendations. Nevertheless, recommendations appear necessary concerning HIV screening in this population.
Collapse
Affiliation(s)
- M Guignant
- Service de dermatologie, centre hospitalier universitaire Charles-Nicolle, 1, rue de Germont, 76031 Rouen cedex, France.
| | - E Mahé
- Service de dermatologie, hôpital Victor-Dupouy, 69, rue du Lieutenant-ColonelPrud'hon, 95100 Argenteuil, France
| | - A-B Duval-Modeste
- Service de dermatologie, centre hospitalier universitaire Charles-Nicolle, 1, rue de Germont, 76031 Rouen cedex, France
| | - A Vermersch-Langlin
- Service de dermatologie/IST, hôpital-Jean Bernard, avenue Desandrouin, 59322 Valenciennes cedex, France
| | -
- Service de dermatologie, centre hospitalier universitaire Charles-Nicolle, 1, rue de Germont, 76031 Rouen cedex, France; Service de dermatologie, hôpital Victor-Dupouy, 69, rue du Lieutenant-ColonelPrud'hon, 95100 Argenteuil, France; Service de dermatologie/IST, hôpital-Jean Bernard, avenue Desandrouin, 59322 Valenciennes cedex, France
| |
Collapse
|
30
|
Abstract
Psoriasis is a prevalent systemic immune-mediated disease with cutaneous manifestations. In HIV-infected patients, psoriasis may have a higher incidence, present atypical and more exuberant clinical features, and is frequently recalcitrant to treatment. Despite this aggravated severity, treatment options for psoriasis in HIV-infected individuals remain limited due to the risk of fatal immunosuppression associated with both classical immunosuppressants and new biological drugs. Notwithstanding, drug therapy in psoriasis has been undergoing major advances for the last few years, with novel drugs approved, which could significantly add to the management of HIV-infected patients. It is therefore our aim to present a review of the available literature to highlight the updated evidence on psoriasis in HIV-infected individuals, particularly in regards to its epidemiology, proposed pathophysiology, clinical presentation, currently available therapeutic options, and future perspectives.
Collapse
Affiliation(s)
- Miguel Alpalhão
- 1 Dermatology and Venereology Department, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisboa, Portugal.,2 Dermatology Investigation Unit, Instituto de Medicina Molecular, Universidade de Lisboa, Lisboa, Portugal
| | - J Borges-Costa
- 1 Dermatology and Venereology Department, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisboa, Portugal.,2 Dermatology Investigation Unit, Instituto de Medicina Molecular, Universidade de Lisboa, Lisboa, Portugal.,3 Clínica Universitária de Dermatologia, Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal
| | - Paulo Filipe
- 1 Dermatology and Venereology Department, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisboa, Portugal.,2 Dermatology Investigation Unit, Instituto de Medicina Molecular, Universidade de Lisboa, Lisboa, Portugal.,3 Clínica Universitária de Dermatologia, Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal
| |
Collapse
|
31
|
Li YY, Dong RJ, Cao LJ, Upadhyay P, Kuang YQ. Case of coincident severe acne and psoriasis in AIDS patient successfully treated with antiretroviral therapy. J Dermatol 2019; 46:431-435. [PMID: 30811070 DOI: 10.1111/1346-8138.14823] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Accepted: 01/17/2019] [Indexed: 11/28/2022]
Abstract
Cutaneous disorders remain a major problem in HIV-infected patients, even under antiretroviral therapy (ART). Patients at any stage of HIV/AIDS may suffer from skin lesions. Acnes and psoriasis are both common chronic and inflammatory skin diseases, and the treatment becomes more challenging and complex when combined with HIV infection. Whether the incidence and severity of acne and psoriasis are related to HIV infection is still controversial. Here, we report a rare case of an AIDS patient who developed severe acne along with psoriasis. The patient had initially received multiple systemic and topical antipsoriatic and anti-acne treatments which failed. Ultimately, he achieved dramatic clinical improvement after initiation of ART for main treatment. An 8-year follow up demonstrated that the patient has been free of symptoms of both psoriasis and acne till now.
Collapse
Affiliation(s)
- Yu-Ye Li
- Department of Dermatology and Venereology, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Rong-Jing Dong
- Department of Dermatology and Venereology, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Li-Juan Cao
- Department of Dermatology and Venereology, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Pratishtha Upadhyay
- Department of Dermatology and Venereology, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Yi-Qun Kuang
- Center for Translational Medicine, Huaihe Clinical College, Huaihe Hospital of Henan University, Kaifeng, China.,Institute of Infection and Immunity, Henan University, Kaifeng, China
| |
Collapse
|
32
|
Abstract
Epidemiological studies suggest a viral etiology in approximately 1% of patients presenting with acute arthritis. The arthritogenic effect of viral infections may be related to viral invasion of synovial cells, the cellular and humoral immune response to viral antigens or by induction of autoimmunity. Viral arthritis can mimic rheumatoid arthritis by presenting as a symmetrical polyarticular disease often accompanied by a rash and influenza-like symptoms. Serological testing for pathogen-specific IgM and IgG antibodies is frequently performed for establishing a viral etiology of arthritis. Virus isolation from the joints or detection of viral nucleic acids in the synovium or synovial fluid is only rarely successful and does not always provide proof of a viral origin of arthritis. While viral arthritis in most cases is self-limiting, protracted disease can occur.
Collapse
|
33
|
Manfreda V, Esposito M, Campione E, Bianchi L, Giunta A. Apremilast efficacy and safety in a psoriatic arthritis patient affected by HIV and HBV virus infections. Postgrad Med 2019; 131:239-240. [PMID: 30700196 DOI: 10.1080/00325481.2019.1575613] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Treatment of psoriasis and psoriatic arthritis in patients with concomitant chronic, severe viral infections, particularly HIV or HBV, represents a challenge, due to contraindication to conventional immunomodulating systemic drugs and biologics, including anti-TNF alpha, anti-IL12/23, and anti-IL17 agents. Recently, apremilast, a selective inhibitor of phosphodiesterase E4 has been suggested to be a safe and effective therapeutic option in HIV-infected population with psoriatic arthritis. We report the case of a patient with psoriatic arthritis and concomitant HIV and HBV infection successfully treated with apremilast.
Collapse
Affiliation(s)
- Valeria Manfreda
- a Department of Dermatology , University of Rome "Tor Vergata" , Rome , Italy
| | - Maria Esposito
- a Department of Dermatology , University of Rome "Tor Vergata" , Rome , Italy
| | - Elena Campione
- a Department of Dermatology , University of Rome "Tor Vergata" , Rome , Italy
| | - Luca Bianchi
- a Department of Dermatology , University of Rome "Tor Vergata" , Rome , Italy
| | - Alessandro Giunta
- a Department of Dermatology , University of Rome "Tor Vergata" , Rome , Italy.,b Dermatology, Department of Clinical Sciences and Translational Medicine, International Medical School , University of Rome "Tor Vergata" , Rome , Italy
| |
Collapse
|
34
|
Ceccarelli M, Venanzi Rullo E, Vaccaro M, Facciolà A, d'Aleo F, Paolucci IA, Cannavò SP, Cacopardo B, Pinzone MR, Pellicanò GF, Condorelli F, Nunnari G, Guarneri C. HIV-associated psoriasis: Epidemiology, pathogenesis, and management. Dermatol Ther 2019; 32:e12806. [PMID: 30588732 DOI: 10.1111/dth.12806] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 12/15/2018] [Accepted: 12/25/2018] [Indexed: 01/14/2023]
Abstract
People living with HIV (PLWH) are affected by a higher incidence skin disorders, which are often associated with high morbidity and mortality. In particular, psoriasis affects PLWH severely and for a longer time than the general population. Human immunodeficiency virus (HIV) infection is characterized by a progressive decrease in CD4+ T-cell count, and it could seem paradoxical that psoriasis exacerbations are more frequent in this subset of patients than the general population, even though it is commonly observed at any stage of infection. For a long time, there have been limited therapeutic choices for PLWH affected by psoriasis. The introduction of the combined antiretroviral therapy dramatically changed the natural course of both HIV and psoriasis in PLWH, leading to an improvement of quality and duration of life. However, the clinical severity of psoriasis in PLWH often requires the use of immunosuppressant drugs. Knowledge about their safety and efficacy are limited to case-reports, small case-series and studies, therefore their use has not yet entered the routine. Further studies are needed to determine if immunosuppressive drugs can be safely and effectively used in PLWH affected by psoriasis and other autoimmune disorders.
Collapse
Affiliation(s)
- Manuela Ceccarelli
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Emmanuele Venanzi Rullo
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.,Department of Pathology and Laboratory Medicine, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Mario Vaccaro
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Alessio Facciolà
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Francesco d'Aleo
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | | | | | - Bruno Cacopardo
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Marilia Rita Pinzone
- Department of Pathology and Laboratory Medicine, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.,Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Giovanni Francesco Pellicanò
- Department of Human Pathology of the Adult and the Developmental Age "G. Barresi", University of Messina, Messina, Italy
| | - Fabrizio Condorelli
- Department of Pharmacological Sciences, Università del Piemonte Orientale "A. Avogadro", Novara, Italy
| | - Giuseppe Nunnari
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Claudio Guarneri
- Department of Biomedical and Dental Sciences and Morpho Functional Imaging, University of Messina, Messina, Italy
| |
Collapse
|
35
|
Psoriasis: Which therapy for which patient. J Am Acad Dermatol 2019; 80:43-53. [DOI: 10.1016/j.jaad.2018.06.056] [Citation(s) in RCA: 169] [Impact Index Per Article: 33.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 05/24/2018] [Accepted: 06/01/2018] [Indexed: 12/17/2022]
|
36
|
Rajesh D, Nagraj S, Kumar KSP, Kutty AVM, Balakrishna S. Evaluation of HCP5 and Chemokine C Receptor type 5 Gene Polymorphisms in Indian Psoriatic Patients. Indian J Dermatol 2019; 64:182-186. [PMID: 31148855 PMCID: PMC6537696 DOI: 10.4103/ijd.ijd_285_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background: Genetic variations associated with nonprogression of HIV infection to AIDS are enriched in psoriasis patients. HCP5 gene 335 T > G and chemokine C receptor type 5 (CCR5) gene Δ32 polymorphisms are associated with HIV nonprogression phenotype. Aim: The aim of this study was to determine the association of HCP5 gene 335 T > G (rs2395029) and CCR5 gene Δ32 (rs333) polymorphisms with psoriasis vulgaris (PV). Materials and Methods: Genotype of HCP5 gene 335 T > G and CCR5 gene Δ32 polymorphisms were determined by polymerase chain reaction (PCR)-restriction fragment length polymorphism and allele-specific PCR methods, respectively. Results: The frequency of HCP5 gene 335 T > G SNP was ~7 times higher in PV patients than in the control group (P = 1.49 × 10–8; odds ratio [OR] = 10.2; 0.95 confidence interval [CI]: 3.9–26.8). OR for the occurrence of HCP5 335 G allele in either homozygous or heterozygous genotype in PV patients was 13.1 (0.95 CI: 4.7–36.1). The strength of association was higher with moderate-to-severe subgroup (P = 3.29 × 10–9; OR = 18.4; 0.95 CI: 6.2–54.9) than with mild subgroup (P = 2.1 × 10–4; OR = 8.3; 0.95 CI: 2.6–23.3). In addition, the strength of association was higher with Type I (P = 9.53 × 10–8; OR = 15.3; 0.95 CI: 5.1–46.5) than with Type II subgroup (P = 6.8 × 10–6; OR = 11.0; 0.95 CI: 3.6–33.9). Type I gene Δ32 polymorphism was observed neither among psoriatic nor among healthy individuals. Conclusions: Our results indicate that HCP5 gene 335 T > G polymorphism and not CCR5 gene Δ32 polymorphism is associated with the increased risk of developing PV.
Collapse
Affiliation(s)
- Deepa Rajesh
- Department of Cell Biology and Molecular Genetics, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, Karnataka, India
| | - Sudeep Nagraj
- Department of Cell Biology and Molecular Genetics, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, Karnataka, India
| | - K S Praveen Kumar
- Department of Cell Biology and Molecular Genetics, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, Karnataka, India
| | - A V Moideen Kutty
- Department of Cell Biology and Molecular Genetics, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, Karnataka, India
| | - Sharath Balakrishna
- Department of Cell Biology and Molecular Genetics, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, Karnataka, India
| |
Collapse
|
37
|
Montes-Torres A, Aparicio G, Rivera R, Vilarrasa E, Marcellán M, Notario J, Soria C, Belinchón I, de la Cueva P, Ferrán M, Carrascosa JM, Gómez FJ, Salgado L, Velasco M, Descalzo MÁ, García-Doval I, Daudén E. Safety and effectiveness of conventional systemic therapy and biological drugs in patients with moderate to severe psoriasis and HIV infection: a retrospective multicenter study. J DERMATOL TREAT 2018; 30:461-465. [PMID: 30307344 DOI: 10.1080/09546634.2018.1535690] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Background: The management of HIV-positive patients with psoriasis is controversial and limited to individual cases or short series of patients. Objectives: To evaluate the safety and effectiveness of conventional and biologic immunosuppressive drugs in the treatment of patients with psoriasis and concomitant HIV infection. Methods: A retrospective multicenter study was conducted. The study included data from 2008 to 2016. Inclusion criteria were: HIV adult patients with moderate-to-severe psoriasis, HIV viral load determinations at baseline and at least after 6 months of treatment, and systemic immunosuppressive treatment for at least 6 months. A descriptive analysis was performed. Results: Twenty-three patients with plaque-type psoriasis and HIV infection (five with AIDS) were included. Median follow-up time was 3.2 years. The main drugs used were etanercept, methotrexate, and ustekinumab. In most cases, viral load and CD4 cell count not only remained stable but also improved throughout the follow-up. Six patients presented severe adverse events during the follow-up, four of them in the AIDS stage. At the end of the follow-up period, 76.5% of the patients had achieved a PASI 75. Conclusion: Biologic drugs, both anti-TNF alpha agents and ustekinumab, seem to have an acceptable safety profile and high effectiveness in HIV-positive patients.
Collapse
Affiliation(s)
- Andrea Montes-Torres
- a Department of Dermatology , Hospital Universitario de La Princesa , Madrid , Spain.,b Department of Dermatology , Hospital Central de la Defensa Gómez Ulla , Madrid , Spain
| | - Gloria Aparicio
- c Department of Dermatology , Hospital Universitario Vall d'Hebron , Barcelona , Spain
| | - Raquel Rivera
- d Department of Dermatology , Hospital Universitario Doce de Octubre , Madrid , Spain
| | - Eva Vilarrasa
- e Department of Dermatology , Hospital Universitario de la Santa Creu i Sant Pau , Barcelona , Spain
| | - María Marcellán
- f Department of Dermatology , Hospital Universitario Marqués de Valdecilla , Santander , Spain
| | - Jaume Notario
- g Department of Dermatology , Hospital Universitario de Bellvitge , L'Hospitalet de Llobregat , Spain
| | - Caridad Soria
- h Department of Dermatology , Hospital General Universitario Reina Sofía , Murcia , Spain
| | - Isabel Belinchón
- i Department of Dermatology , Hospital General Universitario de Alicante , Alicante , Spain
| | - Pablo de la Cueva
- j Department of Dermatology , Hospital Universitario Infanta Leonor , Madrid , Spain
| | - Marta Ferrán
- k Department of Dermatology , Hospital del Mar, Parc de Salut Mar , Barcelona , Spain
| | - Jose Manuel Carrascosa
- l Department of Dermatology , Hospital Universitario Germans Trias i Pujol , Badalona , Spain
| | - Francisco J Gómez
- m Department of Dermatology , Hospital Universitario Reina Sofía , Córdoba , Spain
| | - Laura Salgado
- n Department of Dermatology , Complejo Hospitalario Universitario de Pontevedra , Pontevedra , Spain
| | - Manuel Velasco
- o Department of Dermatology , Hospital Universitario Arnau de Vilanova , Valencia , Spain
| | | | - Ignacio García-Doval
- p Research Unit. Fundación Piel Sana AEDV , Madrid , Spain.,q Department of Dermatology , Complejo Hospitalario Universitario de Vigo , Vigo , Spain
| | - Esteban Daudén
- a Department of Dermatology , Hospital Universitario de La Princesa , Madrid , Spain
| | | |
Collapse
|
38
|
Valenzuela F, Fernández J, Sánchez M, Zamudio A. Erythrodermic psoriasis and human immunodeficiency virus: association and therapeutic challenges. An Bras Dermatol 2018; 93:438-440. [PMID: 29924218 PMCID: PMC6001086 DOI: 10.1590/abd1806-4841.20187387] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 09/05/2017] [Indexed: 11/22/2022] Open
Abstract
Erythrodermic psoriasis is a rare but severe type of psoriasis that may be triggered by human immunodeficiency virus infection. We describe the case of a 65-year-old male patient with chronic psoriasis who presents an exacerbation of his condition over a period of two weeks. Because of the severity of his case and subsequent need for systemic therapy, human immunodeficiency virus enzyme immunoassay was performed and tested positive. He thus began antiretroviral therapy combined with acitretin, showing good clinical response after 8 weeks of treatment. There is little evidence regarding the management of erythrodermic psoriasis associated with HIV infection, so antiretroviral therapy and systemic retinoid remain as the first-line treatment.
Collapse
Affiliation(s)
- Fernando Valenzuela
- Department of Dermatology, Faculty of Medicine, University of
Chile, Santiago, Chile
- Department of Dermatology, Clínica Las Condes, Santiago,
Chile
| | - Javier Fernández
- Department of Dermatology, Faculty of Medicine, University of
Chile, Santiago, Chile
| | - Margarita Sánchez
- Department of Dermatology, Faculty of Medicine, University of
Chile, Santiago, Chile
| | - Andrea Zamudio
- School of Medicine, Faculty of Medicine, University of Chile,
Santiago, Chile
| |
Collapse
|
39
|
Wang DM, Fernandez AP, Calabrese CM, Calabrese LH. Treatment of psoriasis with ustekinumab in a patient with HIV-related Kaposi sarcoma. Clin Exp Dermatol 2018; 44:113-115. [DOI: 10.1111/ced.13630] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2017] [Indexed: 11/28/2022]
Affiliation(s)
- D. M. Wang
- School of Medicine; Case Western Reserve University; Cleveland OH USA
| | - A. P. Fernandez
- Departments of Dermatology and Pathology; Cleveland Clinic Foundation; Cleveland OH USA
| | - C. M. Calabrese
- Department of Rheumatic and Immunological Diseases; Cleveland Clinic Foundation; Cleveland OH USA
| | - L. H. Calabrese
- Department of Rheumatic and Immunological Diseases; Cleveland Clinic Foundation; Cleveland OH USA
| |
Collapse
|
40
|
Queirós N, Torres T. HIV-associated psoriasis. ACTAS DERMO-SIFILIOGRAFICAS 2018. [DOI: 10.1016/j.adengl.2018.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
|
41
|
Lee ES, Heller MM, Kamangar F, Park K, Liao W, Koo J. Hydroxyurea for the Treatment of Psoriasis with an Emphasis on HIV-Infected Psoriasis Patients: A Review. ACTA ACUST UNITED AC 2018. [DOI: 10.1177/247553031117a00302] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Hydroxyurea is a drug that has been long forgotten for the treatment of psoriasis. In addition to its anti-psoriatic effects, it has also been shown to have antiviral effects. This dual effect makes it a drug that dermatologists may want to consider when treating psoriasis in HIV-infected patients. Currently, no studies are available that discuss the safety and efficacy of hydroxyurea in the treatment of psoriasis in this immunocompromised group; however, numerous reports discuss the safety and efficacy of hydroxyurea in psoriasis and HIV separately. This review suggests that hydroxyurea is generally safe and effective. The main risk involves the hematologic adverse events (anemia, leukopenia, thrombocytopenia, and macrocytosis), which appear to be dose dependent. Because of the common hematologic adverse events, hydroxyurea may be considered a viable therapeutic option for patients with generalized psoriasis that is inadequately responsive to other safer options, whether or not the patient is HIV positive.
Collapse
Affiliation(s)
- Eric S. Lee
- Department of Dermatology, Psoriasis and Skin Treatment Center, University of California, San Francisco, California
| | - Misha M. Heller
- Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Faranak Kamangar
- University of California, Davis School of Medicine, Sacramento, California
| | - Kelly Park
- Department of Dermatology, Psoriasis and Skin Treatment Center, University of California, San Francisco, California
| | - Wilson Liao
- Department of Dermatology, Psoriasis and Skin Treatment Center, University of California, San Francisco, California
| | - John Koo
- Department of Dermatology, Psoriasis and Skin Treatment Center, University of California, San Francisco, California
| |
Collapse
|
42
|
Queirós N, Torres T. HIV-Associated Psoriasis. ACTAS DERMO-SIFILIOGRAFICAS 2018; 109:303-311. [PMID: 29361272 DOI: 10.1016/j.ad.2017.09.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Revised: 09/15/2017] [Accepted: 09/26/2017] [Indexed: 01/25/2023] Open
Abstract
Human immunodeficiency virus (HIV) prevalence is increasing worldwide as people on antiretroviral therapy are living longer. These patients are often susceptible to debilitating inflammatory disorders that are frequently refractory to standard treatment. Psoriasis is a systemic inflammatory disorder, associated with both physical and psychological burden, and can be the presenting feature of HIV infection. In this population, psoriasis tends to be more severe, to have atypical presentations and higher failure rates with the usual prescribed treatments. Management of moderate and severe HIV-associated psoriasis is challenging. Systemic conventional and biologic agents may be considered, but patients should be carefully followed up for potential adverse events, like opportunist infections, and regular monitoring of CD4 counts and HIV viral loads.
Collapse
Affiliation(s)
- N Queirós
- Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Porto, Portugal
| | - T Torres
- Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Porto, Portugal; Unidad de Dermatología, Centro Hospitalar e Universitário do Porto, Porto, Portugal.
| |
Collapse
|
43
|
Walker-Bone K, Doherty E, Sanyal K, Churchill D. Assessment and management of musculoskeletal disorders among patients living with HIV. Rheumatology (Oxford) 2017; 56:1648-1661. [PMID: 28013196 DOI: 10.1093/rheumatology/kew418] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Indexed: 12/18/2022] Open
Abstract
HIV is a global pandemic. However, anti-retroviral therapy has transformed the prognosis and, providing compliance is good, a normal life expectancy can be anticipated. This has led to increasing numbers of people with chronic prevalent, treated infection living to older ages. Musculoskeletal pain is commonly reported by HIV patients and, with resumption of near-normal immune function, HIV-infected patients develop inflammatory rheumatic diseases that require assessment and management in rheumatology clinics. Moreover, it is becoming apparent that avascular necrosis and osteoporosis are common comorbidities of HIV. This review will contextualize the prevalence of musculoskeletal symptoms in HIV, informed by data from a UK-based clinic, and will discuss the management of active inflammatory rheumatic diseases among HIV-infected patients taking anti-retroviral therapy, highlighting known drug interactions.
Collapse
Affiliation(s)
- Karen Walker-Bone
- Arthritis Research UK/MRC Centre for Musculoskeletal Health and Work.,Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton
| | - Erin Doherty
- Department of Medicine, Royal United Hospitals Bath NHS Foundation Trust, Bath
| | - Kaushik Sanyal
- Department of Rheumatology, Western Sussex Hospitals NHS Foundation Trust, St Richard's Hospital, Chichester
| | - Duncan Churchill
- Lawson Unit, Brighton & Sussex University Hospitals NHS Trust, Brighton, UK
| |
Collapse
|
44
|
Warren RB, Weatherhead SC, Smith CH, Exton LS, Mohd Mustapa MF, Kirby B, Yesudian PD. British Association of Dermatologists' guidelines for the safe and effective prescribing of methotrexate for skin disease 2016. Br J Dermatol 2017; 175:23-44. [PMID: 27484275 DOI: 10.1111/bjd.14816] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2016] [Indexed: 12/25/2022]
Affiliation(s)
- R B Warren
- The Dermatology Centre, Salford Royal NHS Foundation Trust, The University of Manchester, Manchester Academic Health Science Centre, Manchester, M6 8HD, U.K
| | - S C Weatherhead
- Department of Dermatology, Royal Victoria Infirmary, Newcastle upon Tyne, NE1 4LP, U.K
| | - C H Smith
- St John's Institute of Dermatology, Guy's and St Thomas NHS Foundation Trust, London, SE1 9RT, U.K
| | - L S Exton
- British Association of Dermatologists, Willan House, 4 Fitzroy Square, London, W1T 5HQ, U.K
| | - M F Mohd Mustapa
- British Association of Dermatologists, Willan House, 4 Fitzroy Square, London, W1T 5HQ, U.K
| | - B Kirby
- St Vincent's University Hospital, Elm Park, Dublin, Ireland
| | - P D Yesudian
- Glan Clwyd Hospital, Sarn Lane, Rhyl, LL18 5UJ, U.K
| |
Collapse
|
45
|
Reddy SP, Shah VV, Wu JJ. Apremilast for a psoriasis patient with HIV and hepatitis C. J Eur Acad Dermatol Venereol 2017; 31:e481-e482. [PMID: 28449227 DOI: 10.1111/jdv.14301] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- S P Reddy
- University of Illinois at Chicago College of Medicine, Chicago, IL, USA
| | - V V Shah
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - J J Wu
- Department of Dermatology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA
| |
Collapse
|
46
|
Fink DL, Hedley L, Miller RF. Systematic review of the efficacy and safety of biological therapy for inflammatory conditions in HIV-infected individuals. Int J STD AIDS 2016; 28:110-119. [PMID: 27733707 DOI: 10.1177/0956462416675109] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Biologic therapies are injectable immunomodulatory agents directed against specific immune cell or chemical targets. They have transformed the lives of HIV-uninfected individuals with severe inflammatory conditions including psoriasis, rheumatoid arthritis, and ulcerative colitis. The perceived increased infection risk associated with these agents means that HIV-infected individuals have not been included in randomised control trials of these drugs. The literature for use of biologic therapies in HIV-infected populations is limited to case reports and case series. There are additional data on use of rituximab, a monoclonal antibody against B lymphocytes, in the setting of HIV-associated haematological malignancy. We performed a systematic review of efficacy and safety of biologic therapy for inflammatory conditions in HIV-infected individuals. Our systematic review identified 37 treatment episodes with six different biologic agents encompassing 10 different inflammatory conditions. Broadly, efficacy of the agents studied was comparable to reports from HIV-uninfected patients. Both infectious and non-infectious sequelae were also comparable with trial data from HIV-uninfected patients. HIV control, even for the minority of individuals not receiving anti-retroviral therapy (ART) at the time of biologic therapy, was not adversely affected. However, detail was limited concerning ART regimens and both immunological and virological parameters of follow-up. Overall available literature is of very low quality and likely subject to publication bias of successful cases. Firm conclusions are not possible regarding the efficacy and safety of biologic agents in HIV-infected individuals; however, there appear to be sufficient data to warrant inclusion of individuals with well-controlled HIV in future trial studies.
Collapse
Affiliation(s)
- D L Fink
- 1 Department of Infectious and Tropical Diseases, Hospital for Tropical Diseases, University College London Hospitals NHS Foundation Trust, UK
| | - L Hedley
- 2 Pharmacy Department, University College London Hospitals NHS Foundation Trust, UK
| | - R F Miller
- 3 Research Department of Infection and Population Health, University College London, London, UK.,4 Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| |
Collapse
|
47
|
De Simone C, Perino F, Caldarola G, D'Agostino M, Peris K. Treatment of psoriasis with etanercept in immunocompromised patients: Two case reports. J Int Med Res 2016; 44:67-71. [PMID: 27683143 PMCID: PMC5536537 DOI: 10.1177/0300060515593250] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Tumour necrosis factor (TNF)-α blocking agents have revolutionized the treatment of psoriasis and psoriatic arthritis. Concerns remain about increased susceptibility to infection and onset of malignancies, and the use of TNF-α agents in patients with HIV infection or undergoing immunosuppressant treatment is debated. We report cases of severe plaque psoriasis in a patient with HIV infection and in a liver transplant recipient who were successfully treated with etanercept, an anti-TNF-α agent, without notable side-effects.
Collapse
Affiliation(s)
- Clara De Simone
- Department of Dermatology, Catholic University of the Sacred Heart, Rome, Italy
| | - Francesca Perino
- Department of Dermatology, Catholic University of the Sacred Heart, Rome, Italy
| | - Giacomo Caldarola
- Department of Dermatology, Catholic University of the Sacred Heart, Rome, Italy
| | - Magda D'Agostino
- Department of Dermatology, Catholic University of the Sacred Heart, Rome, Italy
| | - Ketty Peris
- Department of Dermatology, Catholic University of the Sacred Heart, Rome, Italy
| |
Collapse
|
48
|
Suri D, Sharma A, Bhattad S, Rawat A, Arora S, Minz RW, Singh S. Arthritis in childhood human immunodeficiency virus infection predominantly associated with human leukocyte antigen B27. Int J Rheum Dis 2016; 19:1018-1023. [PMID: 27456089 DOI: 10.1111/1756-185x.12947] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM Children with human immunodeficiency virus (HIV) infection usually present with recurrent and unusual infections. Although reported among adults, arthritis as a predominant presentation in children with HIV is rare. Reactive arthritis is considered to be the most common musculoskeletal manifestation in adults with HIV infection. However, in children, septic or HIV-related arthritis has been described. We report four children having arthritis with HIV disease and their long-term outcome; out of which three had human leukocyte antigen (HLA)-B27-related arthritis. It is important to be aware of arthritic presentation of HIV disease in children to prevent delay in diagnosis and initiation of appropriate therapy. METHODS Clinical profile of children with HIV infection who presented with arthritis and registered at the Pediatric Immunodeficiency Clinic at PGIMER, Chandigarh were reviewed and analyzed. RESULTS A total of 796 children with HIV infection are registered in the Pediatric Immunodeficiency Clinic since January 1994. Among these, four children had arthritis, and it was the presenting manifestation in two of them. HLA-B27 related arthritis was noted in three children, while one had HIV-associated arthritis. None of the children had septic arthritis. Arthritis resolved on treatment with antiretroviral therapy (ART) in two children, while others responded to anti-inflammatory agents and the joint symptoms remained quiescent on follow-up with a total follow-up period of 21.5 patient years. CONCLUSIONS Clinicians must be aware of the arthritic presentation of childhood HIV infection. High degree of suspicion must be entertained to screen for HIV infection in children with arthritis, especially in those with reactive arthritis.
Collapse
Affiliation(s)
- Deepti Suri
- Allergy-Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
| | - Avinash Sharma
- Allergy-Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sagar Bhattad
- Allergy-Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Amit Rawat
- Allergy-Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sunil Arora
- Department of Immuno-Pathology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ranjana W Minz
- Department of Immuno-Pathology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Surjit Singh
- Allergy-Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| |
Collapse
|
49
|
Kolios AG, Yawalkar N, Anliker M, Boehncke WH, Borradori L, Conrad C, Gilliet M, Häusermann P, Itin P, Laffitte E, Mainetti C, French LE, Navarini AA. Swiss S1 Guidelines on the Systemic Treatment of Psoriasis Vulgaris. Dermatology 2016; 232:385-406. [DOI: 10.1159/000445681] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Accepted: 03/20/2016] [Indexed: 11/19/2022] Open
|
50
|
Armstrong AW, Aldredge L, Yamauchi PS. Managing Patients With Psoriasis in the Busy Clinic: Practical Tips for Health Care Practitioners. J Cutan Med Surg 2016; 20:196-206. [PMID: 26712930 PMCID: PMC4834511 DOI: 10.1177/1203475415623508] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Psoriasis is a common inflammatory disease with significant comorbidities, whose management can be challenging given the variety of treatment options. It is critical for nurse practitioners, physician assistants, general practitioners, and dermatology trainees to have useful information about the treatment and monitoring of patients with psoriasis. Although certain aspects of care apply to all patients, each therapeutic agent has its own nuances in terms of assessments, dosing, and monitoring. The most appropriate treatment is based not only on disease severity but also on comorbid conditions and concomitant medications. These practitioners are vital in facilitating patient care by thorough understanding of systemic agents, selection criteria, dosing, and recommended monitoring. This article provides high-yield practical pearls on managing patients with moderate to severe psoriasis. It includes case-based discussions illustrating considerations for special populations, such as pregnant women, children, and patients with comorbidities (eg, human immunodeficiency virus infection, hepatitis C, hepatitis B, and history of malignancy).
Collapse
Affiliation(s)
- April W Armstrong
- Department of Dermatology, University of Colorado Denver, Aurora, CO, USA
| | - Lakshi Aldredge
- Department of Dermatology, Portland Veterans Affairs Medical Center, Portland, OR, USA
| | - Paul S Yamauchi
- Dermatology Institute and Skin Care Center, Santa Monica, CA, USA Division of Dermatology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| |
Collapse
|