Psoriasis Severity in HIV Associated With Low CD4 T-Cell Count

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The characteristics of a general psoriasis populations were compared with that of those patients with psoriasis living with HIV.

Among patients with HIV and psoriasis, psoriasis severity is related to a lower age of psoriasis onset, a lower age at HIV diagnosis, and a lower CD4 T-cell count, investigators reported in the Journal of Dermatology.

The retrospective study compared the clinical characteristics of psoriasis in people living with HIV (PLHIV) with those of “general psoriasis patients.”

A total of 73 PLHIV with psoriasis (median age, 54.0 years) and 232 general psoriasis patients (control group; median age, 47.5 years) who visited a psoriasis clinic in Bangkok, Thailand, were included. Psoriasis was diagnosed by a dermatologist; the control individuals did not have a history or symptoms of HIV infection or AIDS-defining illness and attended the clinic from 2020 to 2021.

Male sex (78.1%) was much more prevalent than female sex among PLHIV with psoriasis, and the percentages of male (45.7%) and female patients were comparable in the control group. PLHIV had a significantly higher age at psoriasis onset vs the control group (37.0 vs 30.0 years; P <.001).

Chronic plaque was the most common type in PLHIV (90.4%), which was comparable to the percentage in with general psoriasis patients (89.7%). Pustular psoriasis was significantly less common in PLHIV (2.7%).

The PLHIV group had significantly reduced rates of nail involvement and psoriatic arthritis but a significantly increased rate of co-infectious diseases. The median of the highest percentage of body surface area (BSA) involvement for PLHIV was 24.

A low nadir CD4 T-cell count (<100 cells/μL) was associated with a high severity of psoriasis, and a low CD4 T-cell count at psoriasis diagnosis was associated with psoriasis severity.

Most psoriasis cases among PLHIV were of moderate to high severity (64.4%). However, 29.8% of that group received only topical treatment and were never given any systemic treatment or phototherapy.

“This undertreatment of psoriasis in the PLHIV may have resulted from a major concern for potential drug interactions with antiretroviral therapies, the presence of other comorbidities, and the risk of opportunistic infections,” noted the researchers.

Acitretin was the most frequently used systemic treatment (37%).

Among several limitations, the study was conducted at a clinic specializing in psoriasis at a tertiary-care hospital, which resulted in a high number of patients with moderate to high disease severity. In addition, not all of the control individuals were confirmed to be HIV negative with serological testing.

“The data found by our study reflect the disturbing real-world treatment situation for PLHIV who have psoriasis in a developing country,” stated the study authors. “The treatment of psoriasis in PLHIV is challenging, especially in a middle-income country like Thailand, where patients are typically unable to access appropriate and effective antipsoriatic therapies.”


Chaiyabutr C, Jiamton S, Silpa-Archa N, Wongpraparut C, Wongdama S, Chularojanamontri L. Retrospective study of psoriasis in people living with HIV: Thailand’s experience. J Dermatol. Published online March 15, 2022. doi: 10.1111/1346-8138.16352