Xu Jennifer, Gill Kyra, Flora Akshay, Kozera Emily, Frew John W
Faculty of Medicine, University of New South Wales, New South Wales, Sydney, Australia.
Department of Dermatology, Liverpool Hospital, Sydney, New South Wales, Australia.
J Eur Acad Dermatol Venereol. 2023 Mar 10. doi: 10.1111/jdv.19020.
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.
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.
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.
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.
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.
银屑病是一种慢性免疫介导的炎症性疾病，也可发生于人类免疫缺陷病毒（HIV）感染的情况下。生物疗法改变了银屑病的治疗格局；然而，HIV感染者被排除在临床试验之外。生物疗法对HIV感染者血液参数的影响尚不清楚，仅在少数病例系列中有所观察。
本研究旨在评估生物疗法对HIV病情得到良好控制的寻常型银屑病患者在12个月内CD4细胞计数、CD4比例和HIV病毒载量的影响。
本回顾性队列研究在澳大利亚悉尼的一家三级转诊中心进行，纳入了36例接受生物疗法治疗的HIV阳性银屑病患者，并与2010年至2022年间144例年龄、性别和高效抗逆转录病毒治疗（HAART）匹配的无银屑病患者进行比较。感兴趣的结局包括HIV病毒载量、CD4细胞计数和感染发生率。
有银屑病和无银屑病个体的基线HIV病毒载量和CD4计数无统计学显著差异。在无银屑病的HIV队列中，分析的12个月期间CD4计数或HIV病毒载量无显著变化。接受银屑病生物疗法治疗的HIV队列在检查的12个月期间HIV病毒载量和CD4计数也未显示任何显著变化。按所用生物疗法类型分层未发现这些参数有任何显著变化。各队列之间的感染率和不良事件发生率也无显著差异。生物制剂队列中出现的轻微波动可能是未来病毒学失败的危险因素，需要未来进行前瞻性纵向研究。
在HIV病情得到良好控制的个体中，使用生物疗法治疗银屑病在治疗的前12个月内对HIV病毒载量、CD4细胞计数、CD4比例和感染率无显著影响。
