The human immunodeficiency virus (HIV) is transmitted through certain bodily fluids, which attack the immune system. Research has implicated HIV in the development of autoimmune diseases, including psoriasis. Psoriasis, in particular, is one of the most common skin diseases seen in people with HIV.
Here, we will consider the relationship between psoriasis and HIV, including what causes each condition and how the two may be managed together. If you develop psoriasis or other skin symptoms with HIV, talk to your health care provider about receiving the right diagnosis and treatment. Although neither condition can be cured, both psoriasis and HIV can be managed with medical treatments and home care.
Psoriatic disease is an autoimmune disease, meaning it occurs when the body’s immune system mistakenly attacks its healthy tissues. Psoriatic disease refers to both the skin disease psoriasis and the related condition psoriatic arthritis (PsA). In psoriasis, the immune system in the skin becomes overactive, attacking the skin and leads to an overproduction of skin cells. In psoriatic arthritis, the immune system attacks the joints.
There are several immune cells within the dermis (layer of skin just below the epidermis). In people with psoriasis, certain environmental factors (known as triggers) initiate an immune response, causing these immune cells to produce compounds called cytokines. Cytokines promote inflammation.
Normally, the immune cells in the skin are suppressed by a type of cell known as a regulatory T cell. In a person with psoriasis, however, these T cells cannot properly regulate the immune response, leading to inflammation and the symptoms of psoriasis.
HIV is considered a sexually transmitted infection. Unlike psoriasis, HIV is contagious. It may be spread through the blood or bodily fluids (including blood, semen, vaginal fluids, and breast milk).
Like psoriasis, however, HIV affects the T cells. The virus destroys a type of T cell known as helper T cells (also called CD4 T cells). As their name implies, helper T cells aid other immune cells in fighting against foreign substances such as viruses or bacteria. HIV commandeers these cells and uses them as hosts in which to clone itself. HIV destroys the CD4 cells afterward. This process ultimately weakens the immune system, leaving a person more susceptible to infections.
Although there’s not yet a cure for HIV, it can be successfully managed with a treatment regimen known as antiretroviral therapy (ART). ART involves taking a daily combination of medications. These drugs help reduce HIV’s viral load (the amount of the virus in the body). A person’s viral load is referred to as undetectable when it has become low enough not to show up in test results.
Despite the involvement of T cells in psoriasis and HIV, the connection between the two diseases may come as a surprise. After all, psoriasis results from an overactive immune response, and HIV involves the weakening of the immune system. However, it is important to consider that both conditions result in immune system dysregulation.
Research has found that the diseases appear to be connected. HIV is associated with several inflammatory skin disorders. Psoriasis is the most common, affecting up to five percent of people with the virus (by comparison, psoriasis affects two percent to three percent of the general population). As many as 1 in 10 of those who develop psoriasis with HIV may go on to develop psoriatic arthritis, as well.
Several factors seem to play a role in the development of psoriatic disease in HIV, including autoimmunity (attacks by the immune system on the body’s cells) and genetic predisposition (having a family member with psoriasis or PsA).
Researchers also believe that antiretroviral therapy may contribute to the development of psoriasis. ART helps boost immune system functioning, allowing people with HIV to better fight infections and foreign invaders. This increased immune activity may lead to an increased risk of developing psoriasis. Psoriasis may develop soon after a person starts antiretroviral therapy. In some people, however, ART improves psoriasis symptoms as the immune system strengthens.
The immune attacks seen in psoriasis cause inflammation and accelerate the production of skin cells, causing the skin to build up faster than it can shed. This can lead to the formation of discolored, scaly, dry skin (known as plaques or psoriatic lesions) that can itch, crack, and bleed.
In people with HIV, psoriasis may present with unique patterns or symptoms. Psoriasis tends to be severe, causing skin lesions to appear on more than half of the body, especially in those whose CD4 counts are lower than 200 cells per microliter (one indication of AIDS).
Generally, the lower a person’s CD4 count is, the more severe their psoriasis symptoms will be. If a person already has psoriasis, their symptoms may worsen after contracting HIV. If a person has not yet developed psoriasis, symptoms of the condition may appear for the first time soon after they have contracted HIV.
The treatment of psoriasis alongside HIV can be challenging. Psoriasis is often resistant to standard psoriasis treatments in people with HIV. Moreover, a concern when treating the two together is that many treatments for psoriasis work by suppressing the immune system — a potential risk to people living with HIV, whose immune systems may be compromised.
The symptoms of psoriasis typically improve when HIV is managed with highly active antiretroviral therapy. Dermatologists may recommend the following treatments alongside ART to help manage psoriasis.
Topical treatments like corticosteroid creams and ointments are usually considered the first step in treating mild to moderate psoriasis in people with HIV.
Phototherapy — also known as light therapy or laser treatments — may be used as the first line of treatment for people with moderate to severe psoriasis and HIV. A particular form of phototherapy called psoralen plus ultraviolet A may help manage psoriasis symptoms by reducing T-cell counts and eliminating abnormal T cells circulating in the body.
If a person with HIV has severe psoriasis or if it does not respond to other treatments, systemic treatments may be recommended. Systemic treatments include the immunomodulator Otrexup (methotrexate), the disease-modifying antirheumatic drug (or DMARD) cyclosporine, or biologic medications known as tumor necrosis factor alpha (TNF alpha) inhibitors, which work by blocking the inflammatory cytokine TNF alpha.
Methotrexate and cyclosporine are generally only considered if other treatments have failed, as these drugs suppress the immune system. Biologic drugs, on the other hand, usually do not pose negative side effects when used to treat psoriasis in people with HIV.
Oral retinoids, such as Soriatane (acitretin) and etretinate, may be considered as a second line of treatment for people with HIV who have a psoriatic disease. These medications have been found to improve both skin- and joint-related symptoms associated with psoriasis and PsA without the risk of immune system suppression.
Life with psoriasis has its ups and downs. It can help to have a team by your side that truly understands. MyPsoriasisTeam is the social network for people with psoriatic disease and their loved ones. Nearly 100,000 members from around the world come together to ask questions, offer support and advice, and meet others who understand life with psoriasis and PsA.
Have something to add to the conversation? Share your thoughts in the comments below or by posting on MyPsoriasisTeam.