Effects of Biologic Therapies for Cutaneous Inflammatory Diseases in HIV-Infected Individuals: Reliable or Not?

Abstract

Purpose: Patients with cutaneous inflammatory diseases often present with more aggressive and refractory clinical course in the presence of accompanying human immunodeficiency virus (HIV) infection. Therefore, biologic therapies may be needed to improve outcomes of these patients. The use of biologic agents in HIV positive patients is conflicting because such treatment can lead to increase the risk of infection and malignancy in already immunocompromised patients. On the other hand, some researchers have recommended that HIV management should also include the blockade of tumour necrosis factor-alpha (TNF-α). We discuss the reliability and effectiveness of biologic therapies for patients with cutaneous inflammatory diseases and accompanying HIV infection. Methods: The Medline literature database search through PubMed using the key words 'human immunodeficiency virus', 'cutaneous inflammatory diseases', 'TNF-α inhibitor', 'biologic therapy', 'biologic treatment', 'adalimumab', 'etanercept', 'infliximab,' 'ustekinumab', and 'rituximab' was performed. Literature data associated with biologic therapies of cutaneous inflammatory diseases in HIV-positive patients were evaluated. Results: The literature search identified a total of 17 patients with HIV infection receiving biologic therapy for cutaneous inflammatory diseases (psoriasis, psoriatic arthritis, hidradenitis suppurativa and pemphigus vulgaris) from two case series and 12 case reports. Conclusion: In HIV-infected patients with severe and refractory cutaneous inflammatory diseases, biologic therapies should only be reserved for those whom HIV status is stable at baseline. Screening for tuberculosis prior to treatment and close monitoring for potential side effects are mandatory. Further multicentre randomised controlled trials about the use of biologic agents in these patient groups are necessary.

Hidradenitis Suppurativa in Patients with HIV: A Scoping Review

“…The complexity of the clinical and therapeutic management of HS is burdened by a high rate of clinical failures and recurrences; more so in people living with HIV [ 24 , 26 ]. Depending on the severity of the disease, its extension and patients’ comorbidities, HS treatment includes topical or systemic antibiotics (such as doxycycline, clindamycin, or erythromycin), corticosteroids, isotretinoin, antiandrogens and immunosuppressors [ 6 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 55 , 56 , 57 ]. Severe cases of HS may also require surgical removal of the lesions, thus causing difficult to accept cosmetic alterations [ 25 ].…”

“…Although biologics have already been reported as available therapeutic options for moderate to severe psoriasis [ 61 , 62 ] as they do not interfere with ART response, their use in HIV patients with HS is still controversial, as there is not enough scientific evidence due to the absence of randomized placebo-controlled trials. Moreover, the risk of infectious complications related to biologic therapy in already immunosuppressed patients has limited its use considerably [ 30 , 56 ].…”

“…Several studies have shown a possible role of TNF-alpha in Acquired Immune Deficiency Syndrome (AIDS) manifestations such as fever, fatigue, cachexia, aphthous ulcers and dementia [ 56 ]. Thus, TNF-alpha blockade may play a role in HIV treatment.…”

“…Thus, TNF-alpha blockade may play a role in HIV treatment. On this note, anti-TNFalpha therapy has already been administered to treat immune reconstitution inflammatory syndrome in HIV patients who failed steroid treatment [ 56 ].…”

“…HS in HIV positive patients often presents a more aggressive course and is refractory to standard therapy compared to HIV negative patients [ 56 ]. Biological therapies have begun to be prescribed to reach disease remission in these patients.…”