Psoriasis in HIV infection: an update

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.

Acute Onset of Generalize Pustular Psoriasis in a Patient with Previously Unknown HIV Infection

“…12 T lymphocytes such as Th 17 cells, and inflammatory cytokines like TNF-α and also genetic predispositions play an important role and has been studied that activation of psoriasis causing GPP may be a result of mutations in IL-36 receptor. 10,[13][14][15] In this report, we describe a patient who has no history of psoriasis or HIV infection presenting with initially severe acute onset of pustular psoriatic lesions.…”

“…In the patients with advanced HIV infection, even more than one type of psoriasis can be observed concurrently and this may lead to diagnostic challenges. [7][8][9][10] To the best of our knowledge, psoriasis is the result of alteration of T cells' activity which causes our treatment strategies to target the suppression of T cell hyperactivity. In contradiction with that, in HIV positive patients with decreased T-lymphocyte count, immunosuppression is generally associated with psoriasis.…”

Infection‑provoked psoriasis: Induced or aggravated (Review)

“…Over 80% of HIV-positive patients with psoriasis have recurrent lesions when their CD4 + lymphocyte count reaches <450. Furthermore, previous studies have reported that CD4 + counts <200 cells/mm 3 are associated with a 9-fold higher risk of clinically active psoriasis (76,77). However, the association between CD4 + lymphocyte counts and psoriasis remains controversial.…”

Psoriasis in Patients Attending a Large HIV Clinic in Trinidad

“…In persons living with HIV (PLHIV), dermatologic diseases are very common and may be the initial manifestation of HIV infection and are associated with significant morbidity and mortality [ 9 , 10 ]. Psoriasis has been observed throughout the course of HIV infection ranging in severity from mild to severe and may be the first presentation of HIV infection [ 11 , 12 ] and psoriatic arthritis has been described as more common and severe in these patients [ 10 ]. The prevalence of psoriasis among PLHIV has been reported to be 2–3% [ 10 , 11 , 12 ] but other studies have reported prevalence rates of 4–6% in PLHIV [ 11 , 13 ].…”

“…Psoriasis has been observed throughout the course of HIV infection ranging in severity from mild to severe and may be the first presentation of HIV infection [ 11 , 12 ] and psoriatic arthritis has been described as more common and severe in these patients [ 10 ]. The prevalence of psoriasis among PLHIV has been reported to be 2–3% [ 10 , 11 , 12 ] but other studies have reported prevalence rates of 4–6% in PLHIV [ 11 , 13 ]. HIV infection is associated with a depletion of CD4+ lymphocytes and HIV associated psoriasis tends to present in patients with low CD4+ cell counts and an overall reduced immune status [ 14 ].…”