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Overcoming Obstacles in Managing Psoriasis and HIV

Overcoming Obstacles in Managing Psoriasis and HIV

Dr. Liao

Wilson Liao, MD, professor of dermatology at the University of California San Francisco.

Patients with psoriasis and HIV comprise a unique subgroup that requires special consideration for treatment due to complications and comorbidities associated with both diseases. 

In an interview with The Dermatologist, Wilson Liao, MD, professor of dermatology at the University of California San Francisco, discussed the prevalence of HIV in this patient population, treatment considerations, and challenges dermatologists should consider when managing patients with comorbid HIV and psoriasis.

Q. How common is HIV among patients with psoriasis?

A. We know that among patients with HIV, the prevalence of psoriasis is around 1% to 3%, which is similar to the prevalence of psoriasis in the general population.1 In the United States, we see very few patients born with HIV. Among adults who acquire HIV, psoriasis may present in a more severe or refractory pattern compared with those without HIV.

Q. What are some of the challenges of treating patients with psoriasis and co-HIV infection? Does HIV affect comorbidities and/or treatment outcomes among patients with psoriasis?

A. The main challenge in treating psoriasis in patients who are HIV positive is that some psoriasis treatments are immunosuppressive or immunomodulating. We want to avoid further suppression of the immune system in patients with HIV, so we need to be careful with treatment selection. Also, HIV can make psoriasis less responsive to some therapies.

HIV infection is associated with an increased risk of comorbidities such as cardiovascular disease, kidney dysfunction, and mental health disorders, which is also true for psoriasis. Thus, treating both the HIV and psoriasis is important in reducing the risk of these comorbidities. 

Q. What do you recommend dermatologists consider when treating patients with severe psoriasis and comorbid HIV? 

A. I recommend dermatologists discuss the treatment plan with the patient’s HIV physician. When starting a new systemic agent for psoriasis in a patient who is HIV positive, it is prudent to monitor the CD4 count and viral load at periodic intervals in the first 1 to 2 years of new treatment.

Q. In your opinion, do the recommendations of the National Psoriasis Foundation’s Medical Board provide enough guidance? What other resources are available?

A. The NPF recommendations on treatment of psoriasis in HIV provide a nice foundation.1 In addition, a recent review published in the Journal of American Academy of Dermatology addresses the same topic.2 Also, I would like to emphasize that a collaborative approach between the dermatologist and HIV provider is the best approach. 

References

1. Menon K, Van Voorhees AS, Bebo BF Jr, et al. Psoriasis in patients with HIV infection: from the medical board of the National Psoriasis Foundation. J Am Acad Dermatol. 2010;62(2):291-299. doi:10.1016/j.jaad.2009.03.047

2. Kaushik SB, Lebwohl MG. Psoriasis: Which therapy for which patient: Focus on special populations and chronic infections. J Am Acad Dermatol. 2019;80(1):43-53. doi:10.1016/j.jaad.2018.06.056

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