HIV Outcomes Not Affected During First Year of Biologic Therapy for Psoriasis

 In well-controlled HIV, biologic therapy for psoriasis is not associated with significant perturbations to HIV viral load or CD4+ cell counts, according to study results published in Journal of the European Academy of Dermatology & Venereology.

Researchers from the University of New South Wales in Australia conducted a retrospective cohort study and sourced data from the South-Western Sydney Local Health District. Patients (n=36) living with HIV who received biologic therapy for chronic plaque psoriasis between 2010 and 2022 were included in the study. Changes in HIV-related outcomes in the first 12 months of biologic therapy receipt were compared with age- and gender-matched control participants (n=124) who had HIV but did not have psoriasis.

Participants with psoriasis and control participants were had a median age of 53 (IQR, 11) and 53 (IQR, 10.5) years, and they were diagnosed with HIV 13 (IQR, 5) and 12 (IQR, 4) years prior to receiving biologic therapy, respectively. All participants in both groups were men and all were receiving highly active antiretroviral therapy (HAART).

Participants with psoriasis were receiving ustekinumab (n=9), risankizumab (n=7), secukinumab (n=7), adalimumab (n=7), and etanercept (n=6).

No significant group differences were observed in the change in CD4+ cell count (P =.216), CD4+ proportion (P =.84), or viral load (P =.58) during the study period.

However, significant increases in the variance of the IQR divided by the median was observed among controls for CD4+ cell count (variance, 90.18 vs 112.49; P =.003) and CD4+ proportion (variance, 42.63 vs 72.01; P =.0001). There was also significant variance in the median absolute deviation divided by the median for CD4+ cell count (variance, 333.5 vs 353.7; P =.0003) and CD4+ proportion (variance, 44.40 vs 39.01; P =.0003) compared with the psoriasis group, respectively.

Stratified by group and month, no changes in CD4+ cell count (P =.53), CD4+ proportion (P =.42), or viral load (P =.13) were observed between months 0, 3, 6, or 12 among controls nor among participants with psoriasis (all P ≥.07).

Among the psoriasis group, no changes in CD4+ cell count (all P ≥.668), CD4 proportion (all P ≥.154), or viral load (all P ≥.461) were observed between months 0, 3, 6, or 12 stratified by biologic therapy.

In general, biologic therapy was associated with good control of psoriasis symptoms, in which 100% of patients achieved a 75% improvement in Psoriasis Area and Severity Index (PASI), 66.7% achieved 90% improvement in PASI, and 36.1% achieved 100% improvement in PASI.

Limitations of the study include the lack of generalizability for those who do not have good compliance to HAART, as those individuals were excluded from this analysis.

Study authors conclude, “[T]his data presents evidence that baseline measures of HIV are not significantly different between those with psoriasis and without psoriasis, and that over the first 12 months of therapy, no significant differences are seen between CD4+ count, CD4+ proportion and viral load. Further long-term data is needed regarding whether the frequency of viral load ‘blips’ in individuals with HIV treated with psoriasis biologics may predispose to greater rates of virological treatment failure.”

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.