Clinical and immunological features of psoriasis vulgaris in HIV-infected patients

Abstract

Introduction. Psoriasis is an inflammatory dermatosis, which has characteristic clinical features and is closely associated with immunological changes in the skin. HIV-infected patients suffering from psoriasis have immunological features associated with the effect of HIV virus on CD4+T-lymphocytes.Aim. To identify clinical features of psoriasis in HIV-infected patients depending on the stage of HIV infection and immune status.Materials and methods. An open prospective study (2014–2018) included 143 patients with psoriasis vulgaris, of which 79 (55.2%) were infected with HIV and 64 (44.8%) were not infected with HIV. The groups were comparable in terms of age and gender. The diagnosis of psoriasis vulgaris was established with due account for its clinical presentation and histologically confirmed in 29 (20.3%) patients, of which 17 (58.6%) were infected with HIV and 12 (41.4%) were not infected with HIV. In a biopsy, tissue samples were taken from the areas of inflammatory and healthy skin in each patient. Numbers of CD4+ and CD8+T-lymphocytes in the biopsy samples obtained were calculated using immunohistochemical staining of biopsy. The severity of psoriasis progress was assessed using the psoriasis lesions severity index, taking into account the body surface area covered by lesions, the intensity of erythema, infiltration and sloughing of skin. In the course of the study, the patients had general clinical examinations performed, their HIV infection confirmed or denied, their immune status assessed, and their clinical stage of HIV infection determined.Results and discussion. Mild psoriasis was less often identified, and moderately severe and severe psoriasis was more often observed in HIV-infected patients as compared to HIV-negative patients. The psoriatic plaque CD8+T-lymphocyte counts in HIV-infected patients grew with increasing immunosuppression and clinical stage of HIV infection; these changes were not observed in HIV-negative patients.Сonclusion. HIV-infected patients often have moderately severe (39.2%) and severe (22.8%) psoriasis vulgaris. The psoriatic plaque CD8+T-lymphocyte counts in HIV-infected patients predominate over the CD4+T-lymphocyte counts, while the HIV-negative patients show the opposite test results.