Effects of Biologic Therapies for Cutaneous Inflammatory Diseases in HIV-Infected Individuals: Reliable or Not?

Abstract

Purpose: Patients with cutaneous inflammatory diseases often present with more aggressive and refractory clinical course in the presence of accompanying human immunodeficiency virus HIV infection. Therefore, biologic therapies may be needed to improve outcomes of these patients. The use of biologic agents in HIV positive patients is conflicting because such treatment can lead to increase the risk of infection and malignancy in already immunocompromised patients. On the other hand, some researchers have recommended that HIV management should also include the blockade of tumour necrosis factor-alpha TNF-α . We discuss the reliability and effectiveness of biologic therapies for patients with cutaneous inflammatory diseases and accompanying HIV infection.Methods: The Medline literature database search through PubMed using the key words ‘human immunodeficiency virus’, ‘cutaneous inflammatory diseases’, ‘TNF-α inhibitor’, ‘biologic therapy’, ‘biologic treatment’, ‘adalimumab’, ‘etanercept’, ‘infliximab,’ ‘ustekinumab’, and ‘rituximab’ was performed. Literature data associated with biologic therapies of cutaneous inflammatory diseases in HIV-positive patients were evaluated. Results: The literature search identified a total of 17 patients with HIV infection receiving biologic therapy for cutaneous inflammatory diseases psoriasis, psoriatic arthritis, hidradenitis suppurativa and pemphigus vulgaris from two case series and 12 case reports. Conclusion: In HIV-infected patients with severe and refractory cutaneous inflammatory diseases, biologic therapies should only be reserved for those whom HIV status is stable at baseline. Screening for tuberculosis prior to treatment and close monitoring for potential side effects are mandatory. Further multicentre randomised controlled trials about the use of biologic agents in these patient groups are necessary

Keywords

• human immunodeficiency virus,cutaneous inflammatory diseases,psoriasis and psoriatic arthritis,hidradenitis suppurativa,pemphigus vulgaris,biologic therapy

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