The role of systemic inflammation in HIV-infected patients with moderate and severe psoriasis
E.Yu. Evdokimov, Zh.B. Ponezheva, E.V. Svechnikova, B.M. Gruzdev, A.D. Meshkov, V.S. Pykhtina
1) Central Research Institute of Epidemiology, Moscow, Russia;
2) Polyclinic № 1 of the Administrative Department of the President of the Russian Federation, Moscow, Russia;
3) Novosibirsk State Medical University, Novosibirsk, Russia;
4) Infectious Clinical Hospital № 2 of the Moscow Healthcare Department, Moscow, Russia;
5) Russian Gerontological Research and Clinical Center, Pirogov Russian National Research Medical University, Moscow, Russia
Background. Systemic inflammation is an important indicator of the immune response in chronic diseases. At the same time, it can act as a link between the mutual influence of various diseases among themselves. A convenient, simple indicator of the activity of systemic inflammation is the proportions of blood cells in a complete blood count. Evaluation of the indicators allows to estimate the intensity of inflammation and the mutual influence of chronic diseases.
Objective. Evaluation of the role of systemic inflammation in the combination of HIV infection and psoriasis before and after the use of genetically engineered biological therapy (GIBT) and antiretroviral therapy (ART).
Methods. 30 patients (10 patients with HIV infection+ psoriasis, 10 HIV-infected patients and 10 patients with psoriasis) were examined at the Infectious Clinical Hospital № 2 of the Moscow Healthcare Department, Polyclinic № 1 of the Administrative Department of the President of the Russian Federation and Pirogov Russian Gerontological Research and Clinical Center. PASI values in all patients corresponded to the moderate and severe dermatosis. HIV-infected patients began to receive ART, patients with psoriasis additionally received GIBT. PLR and NLR parameters were assessed in all patients; in HIV-infected patients, the viral load and the number of CD4+ lymphocytes were assessed before the start of treatment and 8 weeks after in dynamics.
Results. Over 8 weeks, in HIV-infected patients with psoriasis the median PLR values shifted from 496.5 to 225.3 (P<0.05), in HIV-infected patients without psoriasis – from 406.3 to 348.6, respectively (Р≤0.1). Median NLR values at week 0 in patients with HIV- infection + psoriasis was 2.3, at week 8 – 1.5; in the HIV-infected group - 2.2 and 1.5, respectively. Viral load of HIV RNA copies (log10) in patients with HIV+ psoriasis at week 0 was 5.8±1.6, and decreased to 3.1±0.7 at week 8 (P<0.05); in HIV-infected patients without psoriasis at week 0 – 5.7±1.1, and at week 8 – 4.2±0.9. The number of CD4+ cells/ml in partients with HIV+psoriasis was 307.5±12.7 and 336.3±14.2, respectively (P<0.05), in HIV-infected patients – 298.2±13.2 and 312.6±10.7. The Psoriasis Severity Scale in HIV-infected patients with psoriasis before treatment was 18.7±4.2, after 8 weeks – 5.3±2.1. Initially, joint pain according to the VAS was 71.2±6.3 points, after 8 weeks – 9.7±4.7.
Conclusion. Systemic inflammation indicators, PLR and NLR, are directly related to PASI values in HIV-infected patients with psoriasis. A higher viral load and a decrease in the number of CD4+ lymphocytes correspond to increased PLR and NLR values. The combination of an IL-17 inhibitor (netakimab) and ART has a beneficial effect on indicators of systemic inflammation in HIV-infected patients with psoriasis.
About the Autors
Corresponding author: Evgeny Yu. Evdokimov, Cand. Sci. (Med.), Researcher, Clinical Department, Central Research Institute of Epidemiology, Moscow, Russia; email@example.com