Psoriasis in HIV infection. Treatment and prevention

Psoriasis is an inflammatory condition that causes skin changes. Psoriasis affects 1% to 3% of people with HIV. Symptoms of psoriasis may appear in the early or late stages of HIV infection.

In this article, we'll look at the connection between psoriasis and HIV and look at the symptoms, treatments, and prevention of psoriasis for people living with the human immunodeficiency virus.

Link between psoriasis and HIV

Advances in HIV treatment, including antiretroviral therapy, now mean that most people with the virus have a life expectancy similar to that of the general population.

However, people with HIV are more susceptible to developing comorbidities and infections, also called opportunistic infections . Therefore, when starting antiretroviral drugs, some people may develop inflammatory conditions such as psoriasis. Doctors call this type of condition an inflammatory immune reconstitution response.

The inflammatory immune reconstitution response affects approximately 20% of people after starting antiretroviral therapy.

In the case of psoriasis, strong antiretroviral therapy and a weakened immune system caused by HIV can sometimes complicate its treatment. However, sometimes antiretroviral therapy can actually improve psoriasis symptoms.

People may also experience skin problems as a common side effect of some HIV medications.

Symptoms of psoriasis

Symptoms of psoriasis vary from person to person and depend on the type of psoriasis. Symptoms of psoriasis usually look like this:

• red spots with silvery scales;
• dry skin;
• cracked and bleeding skin;
• itching;
• pain;
• pinpoint depressions and spotting of the nail plates;
• thickened and crumbling nails.

In addition to skin symptoms, some people with psoriasis experience swollen and painful joints. Doctors call this form of psoriasis psoriatic arthritis. This form develops in approximately 30% of people with psoriasis.

Signs and symptoms of psoriasis may accumulate over several weeks or months until symptoms improve or disappear (remission).

It is worth noting that psoriasis is not contagious. People cannot get it by touching someone with the disease or by sharing towels or personal hygiene items.

Psoriasis is an autoimmune disease. This means that it occurs when the immune system mistakenly attacks skin cells. The body then begins to speed up the process of producing new skin cells, which causes the flakes and patches that characterize psoriasis.

Antiretroviral therapy for psoriasis

In many cases, medications used to treat HIV can also relieve psoriasis symptoms.

According to a study published in the Lancet Infectious Diseases , most people with HIV and psoriasis experience improvements in skin symptoms with antiretroviral therapy.

Antiretroviral therapy is critical for every person with HIV. Treatment may:

• reduce HIV symptoms;
• minimize the risk of opportunistic infections and other complications;
• slow down the progression of the virus;
• prevent transmission of the virus to other people.

Once the viral load in a person's blood becomes undetectable in tests, HIV becomes undetectable.

Treatment of psoriasis with HIV

Managing psoriasis in people with HIV can be challenging for doctors. That's because some treatments for severe psoriasis, known as systemic treatments, suppress the immune system. And as we know, anything that suppresses the immune system is dangerous for people with HIV, since the virus already suppresses the immune system and increases the likelihood of infections.

However, a 2018 review of existing research on HIV and psoriasis reported that the following drugs may be prescribed to patients with HIV and psoriasis:

• Adalimumab;
• Cyclosporine;
• Etanercept;
• Infliximab;
• Methotrexate.

However, systemic treatment is not suitable for everyone, so you should consult your doctor to find the best treatment plan that's right for you.

When treating psoriasis, special creams and ointments can have a positive effect. Some are available without a doctor's prescription, while others are only available with a prescription. Options for creams and ointments include:

• antibacterial soap;
• calcineurin inhibitors;
• coal tar;
• corticosteroid creams;
• moisturizing lotions;
• salicylic acid;
• creams containing vitamin D;
• retinoid drugs.

Also, treatment for psoriasis may include phototherapy (exposing the skin to ultraviolet rays) as an additional measure. However, phototherapy may cause side effects such as dry skin and nausea.

The following remedies can be used as home treatments to reduce the symptoms and ease the discomfort of psoriasis;

• aloe vera gel
• Coconut oil
• dietary supplements containing Omega-3;
• moisturizing lotion;
• warm baths with oatmeal or sea salt.

Prevention of psoriasis in HIV

It is impossible to prevent the occurrence of psoriasis, however, a person can prevent outbreaks of this disease by avoiding provoking factors.

Minimizing your exposure to psoriasis triggers can help reduce your risk of developing psoriasis or reduce the number and severity of outbreaks.

Factors that trigger psoriasis may include:

• food allergies;
• alcohol consumption;
• infections that weaken the immune system, including strep throat, bronchitis and tonsillitis;
• nutritional deficiencies such as vitamin D;
• skin damage such as insect bites or sunburn;
• smoking;
• stress and anxiety;
• use of certain medications, including medications for malaria, high blood pressure, and bipolar disorder;
• weather changes.