Tildrakizumab in the treatment of plaque psoriasis in an HIV+ patient: a case report and literature review of anti-interleukin drugs


Submitted: 13 September 2024
Accepted: 22 October 2024
Published: 11 November 2024
Abstract Views: 99
PDF: 33
SUPPLEMENTARY: 18
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Treatment of psoriasis associated with human immunodeficiency virus (HIV) infection is challenging due to the high incidence of comorbidities and polypharmacy and the lack of evidence on the efficacy and safety of available drugs in these patients. Therefore, clinical or anecdotal reports provide useful indications for therapy decision-making. A 64-year male with plaque psoriasis (Psoriasis Area and Severity Index=14.3) infected with HIV for 4 years, with hypercholesterolemia, hypertension, and impaired quality of life (Dermatology Life Quality Index=14) was resistant to topical therapy and acitretin. Tildrakizumab 200 mg was started, obtaining Psoriasis Area and Severity Index=0 at week 16 which was maintained after 13 months of follow-up. No adverse event was reported, and immune cell levels were unchanged. This is the first report on the treatment of psoriasis with tildrakizumab in an HIV+ patient. A literature search showed that prior to this patient, 38 HIV+ subjects had been treated with anti-cytokine agents for psoriasis.


Parisi R, Iskander IY, Kontopantelis E, et al. National, regional, and worldwide epidemiology of psoriasis: systematic analysis and modelling study. BMJ 2020;369:m1590. DOI: https://doi.org/10.1136/bmj.m1590

Ceccarelli M, Rullo EV, Vaccaro M, et al. HIV-associated psoriasis: epidemiology, pathogenesis, and management. Dermatol Ther 2019;32:e12806. DOI: https://doi.org/10.1111/dth.12806

Alpalhão M, Borges-Costa J, Filipe P. Psoriasis in HIV infection: an update. Int J STD AIDS 2019;30:596-604. DOI: https://doi.org/10.1177/0956462419827673

Xu J, Gill K, Flora A, et al. The impact of psoriasis biologic therapy on HIV viral load and CD4+ cell counts in HIV-positive individuals: A real-world cohort study. J Eur Acad Dermatol Venereol 2023. DOI: https://doi.org/10.1111/jdv.19020

Kaushik SB, Lebwohl MG. Psoriasis: Which therapy for which patient: Focus on special populations and chronic infections. J Am Acad Dermatol 2019;80:43-53. DOI: https://doi.org/10.1016/j.jaad.2018.06.056

Aguilar-Company J, Lopez-Olivo MA, Ruiz-Camps I. Multidisciplinary approach to treatment with immune checkpoint inhibitors in patients with HIV, tuberculosis, or underlying autoimmune diseases. Front Med (Lausanne) 2022;9:875910. DOI: https://doi.org/10.3389/fmed.2022.875910

Gisondi P, Fargnoli MC, Amerio P, et al. Italian adaptation of EuroGuiDerm guideline on the systemic treatment of chronic plaque psoriasis. Ital J Dermatol Venerol 2022;157(Suppl. 1 to No. 1):1-78. DOI: https://doi.org/10.23736/S2784-8671.21.07132-2

Jugovac V, Gulin M, Barić D, et al. Treatment of plaque-psoriasis in HIV-positive patients. Acta Dermatovenerol Alp Pannonica Adriat 2024;33:37-40. DOI: https://doi.org/10.15570/actaapa.2024.8

De Simone C, Fargnoli MC, Amerio P, et al. Risk of infections in psoriasis: assessment and challenges in daily management. Expert Rev Clin Immunol 2021;17:1211-1220. DOI: https://doi.org/10.1080/1744666X.2021.1997592

Dapavo P, Burlando M, Guarneri C, et al. Tildrakizumab: the value of a personalized and flexible approach for treating moderate-to severe plaque psoriasis in patients with high body weight or high disease burden. Expert Opin Biol Ther 2024;24:133-138. DOI: https://doi.org/10.1080/14712598.2024.2325547

Ghazawi FM, Mahmood F, Kircik L, et al. A review of the efficacy and safety for biologic agents targeting IL-23 in treating psoriasis with the focus on tildrakizumab. Front Med (Lausanne) 2021;8:702776. DOI: https://doi.org/10.3389/fmed.2021.702776

Montes-Torres A, Aparicio G, Rivera R, et al. Safety and effectiveness of conventional systemic therapy and biological drugs in patients with moderate to severe psoriasis and HIV infection: a retrospective multicenter study. J Dermatolog Treat 2019;30:461-465. DOI: https://doi.org/10.1080/09546634.2018.1535690

Nordgaard-Lassen I, Dahlerup JF, Belard E, et al. Guidelines for screening, prophylaxis and critical information prior to initiating anti TNF-alpha treatment. Dan Med J 2012;59:C4480.

Motolese A, Ceccarelli M, Macca L, et al. Novel therapeutic approaches to psoriasis and risk of infectious disease. Biomedicines. 2022;10:228. DOI: https://doi.org/10.3390/biomedicines10020228

Yamanaka-Takaichi M, Ghanian S, Katzka DA, et al. Candida infection associated with anti-IL-17 medication: a systematic analysis and review of the literature. Am J Clin Dermatol 2022;23:469-480. DOI: https://doi.org/10.1007/s40257-022-00686-z

Sood S, Geng R, Heung M, et al. Use of biologic treatment in psoriasis patients with HIV: A systematic review. J Am Acad Dermatol 2024;91:107-108. DOI: https://doi.org/10.1016/j.jaad.2024.02.042

Estevinho T, Freitas E, Torres T. Risankizumab, a therapeutic alternative for psoriasis in people living with HIV. J Int Med Res. 2024;52:3000605241229324. DOI: https://doi.org/10.1177/03000605241229324

Myers B, Thibodeaux Q, Reddy V, et al. Biologic Treatment of 4 HIV-Positive Patients: A Case Series and Literature Review. J Psoriasis Psoriatic Arthritis. 2021;6:19-26. DOI: https://doi.org/10.1177/2475530320954279

Thaci D, Piaserico S, Warren RB, et al. Five-year efficacy and safety of tildrakizumab in patients with moderate-to-severe psoriasis who respond at week 28: pooled analyses of two randomized phase III clinical trials (reSURFACE 1 and reSURFACE 2). Br J Dermatol 2021;185:323-334. DOI: https://doi.org/10.1111/bjd.19866

Drerup KA, Seemann C, Gerdes S, Mrowietz U. Effective and safe treatment of psoriatic disease with the anti-IL-23p19 biologic tildrakizumab: results of a real-world prospective cohort study in non selected patients. Dermatology 2022;238:615-619. DOI: https://doi.org/10.1159/000519924

Lora, V., Graceffa, D., Di Prete, M., & Cota, C. (2024). Tildrakizumab in the treatment of plaque psoriasis in an HIV+ patient: a case report and literature review of anti-interleukin drugs. Dermatology Reports. https://doi.org/10.4081/dr.2024.10140

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