The impact of psoriasis biologic therapy on HIV viral load and CD4⁺ cell counts in HIV‐positive individuals: A real‐world cohort study

Abstract

Background Psoriasis is a chronic immune‐mediated inflammatory disorder that also occurs in the setting of human immunodeficiency virus (HIV). Biological therapy has transformed the treatment landscape for psoriasis; however, individuals with HIV are excluded from clinical trials. The impact of biological therapy on blood parameters in HIV is unclear and is only observed in small case series. Objective The aim of this study was to assess the effect of biological therapy in psoriasis vulgaris in individuals with well‐controlled HIV on CD4+ cell counts, CD4+ proportion and HIV viral load over 12 months. Methods This retrospective cohort study was conducted at a tertiary referral centre in Sydney, Australia and included 36 HIV‐positive individuals with psoriasis treated with biological therapy, compared with 144 age‐, gender‐ and HAART‐matched individuals without psoriasis seen between 2010 and 2022. Outcomes of interest included HIV viral load, CD4+ cell count and incidence of infections. Results No statistically significant difference was seen in baseline HIV viral load and CD4+ count between individuals with and without psoriasis. No significant change in CD4+ count or HIV viral load was seen over the 12‐month period of analysis in the HIV cohort without psoriasis. The HIV cohort treated with biological therapy for psoriasis also did not demonstrate any significant change in HIV viral load and CD4+ counts over the 12‐month period examined. Stratification by type of biological therapy used did not identify any significant changes in these parameters. Rates of infections and adverse events were also not significantly different between cohorts. It is possible that minor blips seen in the biologics cohort may be a risk factor for future virological failure, and future prospective longitudinal studies are required. Conclusions In individuals with well‐controlled HIV, the use of biological therapy for psoriasis does not significantly impact HIV viral load, CD4+ cell count, CD4+ proportion and rates of infection over the first 12 months of therapy.

Risankizumab, a therapeutic alternative for psoriasis in people living with HIV

“…8,9 However, the efficacy and safety data for biologics in PLHIV are very limited, as this patient group tends to be excluded from clinical trials. 10,11 This current report presents a case series of two HIV-positive individuals with psoriasis who were effectively treated with risankizumab, a selective interleukin-23 (IL-23) inhibitor, without encountering any safety issues.…”

“…8 , 9 However, the efficacy and safety data for biologics in PLHIV are very limited, as this patient group tends to be excluded from clinical trials. 10 , 11 …”

Managing psoriasis in HIV‐positive patients in the era of biologics

“…Xu et al 4 go one step further with their interesting retrospective study in 36 patients with well‐controlled HIV on ART and undergoing biological treatment for psoriasis. This group is compared to controls with similar characteristics but without psoriasis.…”