Department of Dermatology, New York University, New York, New York 10016-6497, USA.
J Am Acad Dermatol. 2010 Feb;62(2):291-9. doi: 10.1016/j.jaad.2009.03.047. Epub 2009 Jul 31.
Patients with psoriasis and HIV infection often present with more severe and treatment-refractory cutaneous disease. In addition, many of these patients have significant psoriatic arthritis. Many effective drugs for psoriasis and psoriatic arthritis are immunosuppressive. Therefore, therapy for the HIV-infected patient is more challenging, requiring both careful consideration of the potential risks and benefits of treatment and more fastidious monitoring for potential adverse events.
A task force of the National Psoriasis Foundation Medical Board was convened to evaluate treatment options. Our aim was to arrive at a consensus on therapy for psoriasis in patients with HIV.
A MEDLINE search of the terms "psoriasis," "psoriatic arthritis," "human immunodeficiency virus (HIV)," and "HIV skin diseases" was performed and literature relevant to HIV-associated psoriasis and the treatment of HIV-associated psoriasis were reviewed.
Based on a review of the literature, 29 reports were included as evidence in this review. Topical therapy is the first-line recommended treatment for mild to moderate disease. For moderate to severe disease, phototherapy and antiretrovirals are the recommended first-line therapeutic agents. Oral retinoids may be used as second-line treatment. For more refractory, severe disease, cautious use of cyclosporine, methotrexate, hydroxyurea, and tumor necrosis factor-alpha inhibitors may also be considered.
There are no randomized, placebo-controlled trials evaluating the therapeutic efficacy or safety of treatments for patients with HIV-associated psoriasis; consequently, the evidence supporting this review consists mainly of case reports or case series.
HIV-associated psoriasis is often refractory to traditional treatments. Treatment is challenging and requires careful consideration and should be tailored to patients based on disease severity and the input from an infectious disease specialist. Close monitoring for potential adverse events is necessary.
患有银屑病和 HIV 感染的患者通常表现出更严重且治疗抵抗的皮肤疾病。此外，这些患者中有许多患有严重的银屑病关节炎。许多治疗银屑病和银屑病关节炎的有效药物具有免疫抑制作用。因此，HIV 感染患者的治疗更具挑战性，不仅需要仔细考虑治疗的潜在风险和益处，还需要更严格地监测潜在的不良反应。
国家银屑病基金会医学委员会的一个工作组被召集来评估治疗方案。我们的目标是就 HIV 感染患者的银屑病治疗达成共识。
对“银屑病”、“银屑病关节炎”、“人类免疫缺陷病毒（HIV）”和“HIV 皮肤疾病”等术语进行 MEDLINE 搜索，并对与 HIV 相关的银屑病和 HIV 相关的银屑病治疗相关的文献进行了综述。
基于对文献的回顾，有 29 份报告被纳入本综述作为证据。局部治疗是轻度至中度疾病的一线推荐治疗方法。对于中度至重度疾病，光疗和抗逆转录病毒药物是推荐的一线治疗药物。口服类视黄醇可作为二线治疗。对于更难治、严重的疾病，谨慎使用环孢素、甲氨蝶呤、羟基脲和肿瘤坏死因子-α抑制剂也可以考虑。
没有评估治疗 HIV 相关银屑病的治疗疗效或安全性的随机、安慰剂对照试验；因此，支持本综述的证据主要包括病例报告或病例系列。
HIV 相关的银屑病通常对传统治疗方法有抗性。治疗具有挑战性，需要仔细考虑，并应根据疾病严重程度和传染病专家的意见为患者量身定制。需要密切监测潜在的不良反应。
