The impact of psoriasis biologic therapy on HIV viral load and CD4+ cell counts in HIV-positive individuals: A real-world cohort study

BackgroundPsoriasis 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. ObjectiveThe 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. MethodsThis 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. ResultsNo 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. ConclusionsIn 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.

Automated summary

This study aimed to assess the impact of biological therapy on CD4(+) cell counts, CD4(+) proportion, and HIV viral load in individuals with well-controlled HIV and psoriasis. The study found that biological therapy for psoriasis does not significantly affect HIV viral load, CD4(+) cell count, CD4(+) proportion, and rates of infection in individuals with HIV. This study is important as it provides preliminary evidence for the use of biological therapy in individuals with HIV.