Biologic Therapies in HIV-infected Patients with Psoriasis: An Italian Experience

Challenges in the treatment of psoriasis with biologics: vaccination, history of malignancy, human immunodeficiency virus (HIV) infection, and pediatric psoriasis

“…When deciding on the most adequate biologic agent to treat an HIV‐positive psoriasis patient, there are various argumentations. Because of the knowledge that elevated TNF levels are associated with higher virus replication and disease progression, it would be reasonable to favor TNF over IL‐12/23 inhibitors . However, there are more documented cases of infectious complications in HIV‐infected patients treated with anti‐TNF agents than in those treated with ustekinumab, which on the other hand could also lie on the fact that they are available over a longer period of time .…”

“…Because of the knowledge that elevated TNF levels are associated with higher virus replication and disease progression, it would be reasonable to favor TNF over IL‐12/23 inhibitors . However, there are more documented cases of infectious complications in HIV‐infected patients treated with anti‐TNF agents than in those treated with ustekinumab, which on the other hand could also lie on the fact that they are available over a longer period of time . It therefore becomes evident that the decision on which agent to choose should be individualized and of course always in close cooperation with HIV‐specialized infectiologists…”

“…Despite the fact that ustekinumab is a more recent biologic agent compared to TNF inhibitors, there are numerous reports of successful administration in HIV-positive psoriasis patients. 30,32,33 Like with TNF inhibitors, ustekinumab not only shows a good safety profile but also seems to achieve good therapeutic outcomes. 33 In more than one study, it is demonstrated that the CD4 count as well as the viral load not only remain stable but also improve in some cases.…”

Treatment of psoriasis with ustekinumab in a patient with HIV-related Kaposi sarcoma

“…There is a growing literature of case reports and series describing the use of biologic agents for treating HIV‐associated psoriasis. Ustekinumab, a monoclonal antibody that inhibits activity of interleukin (IL)‐12 and IL‐23, has been reported to significantly improve HIV‐associated psoriasis in several cases refractory to standard treatments without compromising control of HIV . However, treatment of an HIV‐positive patient with both severe psoriasis and KS has not been described for ustekinumab or any other biologic medication, to our knowledge.…”

Secukinumab in an HIV‐positive patient with psoriasis

“…The frequency of case reports and small case series in the literature has increased in recent years, demonstrating a reasonable safety profile of TNF-α inhibitors, in particular etanercept [4,5] or ustekinumab in HIV patients. CD4 and viral counts have improved or remained stable following treatment [6][7][8][9]. On the other hand, there are no reports, to our knowledge, on the treatment of psoriasis with IL-17 inhibitors in HIV patients.…”