Psoriasis e infección por el virus de la inmunodeficiencia humana

Psoriasis in Patients Attending a Large HIV Clinic in Trinidad

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.

Phototherapy

Of all the therapeutic options available in Dermatology, few of them have the history, effectiveness, and safety of phototherapy. Heliotherapy, NB-UVB, PUVA, and UVA1 are currently the most common types of phototherapy used. Although psoriasis is the most frequent indication, it is used for atopic dermatitis, vitiligo, cutaneous T-cell lymphoma, and cutaneous sclerosis, among others. Before indicating phototherapy, a complete patient assessment should be performed. Possible contraindications should be actively searched for and it is essential to assess whether the patient can come to the treatment center at least twice a week. One of the main method limitations is the difficulty that patients have to attend the sessions. This therapy usually occurs in association with other treatments: topical or systemic medications. Maintaining the regular monitoring of the patient is essential to identify and treat possible adverse effects. Phototherapy is recognized for its benefits and should be considered whenever possible.

Safety and effectiveness of conventional systemic therapy and biological drugs in patients with moderate to severe psoriasis and HIV infection: a retrospective multicenter study

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.

HIV-Associated Psoriasis

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.

Evaluation of the Innate Immune Modulator Acitretin as a Strategy To Clear the HIV Reservoir

The persistence of HIV despite suppressive antiretroviral therapy is a major roadblock to HIV eradication. Current strategies focused on inducing the expression of latent HIV fail to clear the persistent reservoir, prompting the development of new approaches for killing HIV-positive cells. Recently, acitretin was proposed as a pharmacological enhancer of the innate cellular defense network that led to virus reactivation and preferential death of infected cells. We evaluated the capacity of acitretin to reactivate and/or to facilitate immune-mediated clearance of HIV-positive cells. Acitretin did not induce HIV reactivation in latently infected cell lines (J-Lat and ACH-2). We could observe only modest induction of HIV reactivation by acitretin in latently green fluorescent protein-HIV-infected Jurkat cells, comparable to suboptimal concentrations of vorinostat, a known latency-reversing agent (LRA). Acitretin induction was insignificant, however, compared to optimal concentrations of LRAs. Acitretin failed to reactivate HIV in a model of latently infected primary CD4+ T cells but induced retinoic acid-inducible gene I (RIG-I) and mitochondrial antiviral signaling (MAVS) expression in infected and uninfected cells, confirming the role of acitretin as an innate immune modulator. However, this effect was not associated with selective killing of HIV-positive cells. In conclusion, acitretin-mediated stimulation of the RIG-I pathway for HIV reactivation is modest and thus may not meaningfully affect the HIV reservoir. Stimulation of the RIG-I-dependent interferon (IFN) cascade by acitretin may not significantly affect the selective destruction of latently infected HIV-positive cells.

A Case of Severe HIV-Associated Psoriasis Successfully Treated with Acitretin Therapy

Psoriasis is a chronic inflammatory skin disease that involves immune-mediated cutaneous inflammation and keratinocyte hyperproliferation. Psoriasis in patients with HIV responds poorly to treatment and has a high morbidity rate, thus posing a challenge to clinicians. Until now, there have been no documented cases of acitretin therapy for HIV-associated psoriasis in Korea. Here, we report a case of safe and successful therapy with acitretin in a 52-year-old man with HIV-associated psoriasis that responded poorly to previous treatments including steroids and ultraviolet B phototherapy. We also review the relevant literature.

Severe skin forms of psoriasis in black africans: epidemiological, clinical, and histological aspects related to 56 cases

Bacground. Psoriasis is an erythematosquamous dermatosis of chronic development. In sub-Saharan Africa, few studies have been focused on complicated forms of psoriasis. Objective. The aim is to describe epidemiological, clinical, and histological features of severe skin forms of psoriasis in Cote d'Ivoire. Material and Methods. The study was both cross-sectional and descriptive, that focused on patient admitted to the dermatology unit for complicated psoriasis, from January 1st, 1986, to December 31th, 2007. Results. Fifty-six patients admitted to hospital for severe skin forms of psoriasis were recorded and included in our study over 7.503 patients hospitalized during the study period. They represented 0.75% of cases. The average age was 39.6 ± 3.3 years. There were 49 male (87.5%) and 7 female patients (12.5%) with a sex ratio of 7. At socioprofessional level, 48 patients (87.5%) were from category 1. Patients' history was dominated by the psoriasis vulgaris. Physical and general signs were dominated by itching (58.9%). The three severe skin forms were observed with predominant erythrodermic psoriasis (60.7%). Fifteen patients (34.9%) were HIV positive. Conclusion. Severe skin forms of psoriasis are rare in our setting. But in the quarter of HIV-positive patients, they are dominated by the erythrodermic psoriasis.

Severe cutaneous and arthritic psoriasis in patient with AIDS: a good outcome with therapy using etanercept

We report the case of a patient with cutaneous and arthropathic psoriasis for eight years, whose sudden increased severity of the clinical picture led to a diagnosis of AIDS, emphasizing the importance of the specialist in the diagnosis of systemic diseases. The appropriate therapeutic interventions, including antiretroviral therapy and the immunobiological agent etanercept, enabled rapid improvement of symptoms and quality of life of the patient, besides contributing to delay in immunodeficiency progression.

Particular clinical presentations of psoriasis in HIV patients

Patients with HIV infection have a higher propensity for infectious, inflammatory, neoplastic and metabolic disorders. The link with psoriasis vulgaris is explained by well-known pathophysiological phenomena and can be observed at any stage of infection. The aim of our study was to characterize the clinical spectrum of psoriasis in a group of 50 patients with HIV. Our findings showed particular clinical presentations of psoriasis in those patients, suggesting a predilection for scalp lesions, palmoplantar keratoderma and flexural involvement, as well as a trend towards severe immunodeficiency. Psoriasis, a frequent reason for consultation, allows earlier suspicion and diagnosis of HIV in the presence of these particular patterns.