Duvic M, Johnson T M, Rapini R P, Freese T, Brewton G, Rios A
Department of Dermatology, University of Texas Health Sciences Center, Houston.
Arch Dermatol. 1987 Dec;123(12):1622-32.
Human immunodeficiency virus (HIV) causes a spectrum of immunodysfunction, the most severe of which is the acquired immunodeficiency syndrome (AIDS). We have followed the course of psoriasis in 13 patients over 2 1/2 years in a population of more than 1000 HIV-positive individuals. Four patients had a history of mild psoriasis that became severe and uncontrollable as symptoms of immunodeficiency developed. Psoriasis and HIV positivity, AIDS-related complex, or AIDS simultaneously developed in nine patients. In addition to psoriasis, Reiter's syndrome (arthritis, urethritis, and conjunctivitis) developed in one patient in the first group and three patients in the second group. Opportunistic infections, especially candidiasis and Staphylococcus, drugs, and an altered immune system may contribute to the development or flare of psoriasis in these patients. The appearance of severe psoriasis (especially in a patient with other risk factors for HIV) should prompt evaluation for HIV, and may be a poor prognostic indicator in HIV-positive patients, since nine of our 13 patients have died. Immunosuppressive therapy with methotrexate is contraindicated in this group of patients. Newer forms of drug therapy including etretinate show promising results for the management of AIDS-associated psoriasis.
人类免疫缺陷病毒（HIV）会引发一系列免疫功能紊乱，其中最严重的是获得性免疫缺陷综合征（AIDS）。在1000多名HIV阳性个体中，我们对13名患者的银屑病病程进行了长达两年半的跟踪。4名患者有轻度银屑病病史，随着免疫缺陷症状的出现，病情变得严重且无法控制。9名患者同时出现银屑病与HIV阳性、艾滋病相关综合征或艾滋病。除银屑病外，第一组中有1名患者、第二组中有3名患者出现了赖特综合征（关节炎、尿道炎和结膜炎）。机会性感染，尤其是念珠菌病和葡萄球菌感染、药物以及免疫系统改变，可能促使这些患者发生银屑病或病情加重。严重银屑病的出现（尤其是在有其他HIV危险因素的患者中）应促使对HIV进行评估，并且这可能是HIV阳性患者预后不良的指标，因为我们的13名患者中有9人已经死亡。该组患者禁忌使用甲氨蝶呤进行免疫抑制治疗。包括阿维A在内的新型药物疗法在治疗艾滋病相关银屑病方面显示出了有前景的效果。
