Successful treatment with secukinumab in an HIV-positive psoriatic patient after failure of apremilast

Systematic review of biologic use for psoriasis in HIV-positive individuals from 2018 to 2024

Psoriasis is a chronic, inflammatory systemic condition mediated by T-lymphocyte activation. In patients with concomitant human immunodeficiency virus (HIV) infection, treatment of psoriasis remains a therapeutic challenge due to disruptions in the immune system targeting the quality and quantity of T-cell counts. Limited data exists on the knowledge of the utilization and tolerance of small-molecule and biologic therapies used for psoriasis in HIV-positive (HIV +) individuals. This study aims to provide an updated review detailing reports of efficacy and safety trends currently reported in the literature. A systematic review of PubMed, Cochrane, and Embase databases between January 2018 and April 2024 was performed, which included original investigations, reviews, case reports, and series of reported individuals with a prior diagnosis of psoriasis, and either a previous, or novel diagnosis of HIV during initiation of treatment. 19 articles with 24 cases were included in this review, including treatments apremilast (n = 5), adalimumab (n = 1), etanercept (n = 2), ustekinumab (n = 4), secukinumab (n = 5), ixekizumab (n = 2), brodalumab (n = 1), guselkumab (n = 1), and risankizumab (n = 3). Treatments were effective at improving cutaneous symptoms of psoriasis in all cases and 2 cases reported alleviation of psoriatic arthritis. Adverse events were seldom reported and were managed without interruption of medication. Higher evidence research is necessary to objectively determine the efficacy and safety profiles of these therapies in HIV + individuals.

Successful Biological Treatment of a Patient With Psoriasis and HIV

The use of biological agents for the management of chronic dermatological pathologies such as psoriasis is becoming more common every day. Until now, antibodies against tumor necrosis factors (TNF-α) inhibitors, interleukin IL-17 inhibitors, IL-12/23 inhibitors, and IL-23 inhibitors have been marketed as biological therapies for psoriasis, showing excellent results with a minimal number of adverse events. Initially, the first biological treatments were associated primarily with opportunistic infections. Later, specific adverse events were described depending on the biological agent used: TNF-α inhibitors were linked to tuberculosis, while anti-IL-17 agents were associated with candidiasis and worsening of inflammatory bowel disease (IBD). However, such therapies warrant a cautious screening protocol to detect pre-existing infections, mainly tuberculosis and chronic viral infections such as hepatitis. Human immunodeficiency virus (HIV) is only screened in case of suspicion and in some institutional protocols. We present the clinical case of a person living with HIV under optimal virological control, in which the use of biological therapy was imperative to control psoriasis and he also presented with great severity. Until now there is no official statement on the use or not of biologicals in this particular population.

Biologic Therapies in HIV/AIDS Patients with Inflammatory Diseases: A Systematic Review of the Literature

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.