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Dupilumab for Treatment of Atopic Dermatitis in Patients Living With HIV
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In this case series, 4 patients living with HIV who developed treatment-resistant atopic dermatitis, photodermatitis, or prurigo nodularis after initiating HAART were treated with dupilumab. Within months of starting dupilumab 300 mg every other week, all patients noted partial or full skin clearance and resolution of pruritus. While 2 patients developed viral warts and 1 patient had an upper respiratory tract infection treated with azithromycin, no serious infections were reported in this cohort. Additionally, HIV viral load and CD4 counts were stable in these patients after >1 year on dupilumab.
- Dupilumab could be a safe and effective treatment option for atopic dermatitis and pruritic disorders in patients living with HIV. Further studies including a larger cohort are needed to validate these findings.
abstract
This abstract is available on the publisher's site.
Access this abstract nowHuman immunodeficiency virus (HIV) infection is known to be associated with a wide spectrum of cutaneous manifestations that have continued to evolve in the era of highly active antiretroviral therapy (HAART).1, 2 Patients living with HIV (PLWH) have increased risk of infectious, inflammatory, and neoplastic skin disorders,3 reflective of HIV‐induced dysregulation of the immune system.4 Atopic dermatitis and disorders of pruritus have incidence as high as 37.5% in PLWH attributed to accentuated Th2 response in HIV.1 These disorders can be particularly challenging to treat, often refractory to multiple treatment modalities.1, 5 Treatment may be further limited by provider hesitancy to use systemic immunomodulatory agents, given risk of further compromising the immune system in these patients. In this article, we describe a series of four PLWH treated with dupilumab for atopic dermatitis and other pruritic disorders, achieving considerable clinical improvement while maintaining control of HIV.
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Dupilumab for Treatment of Atopic Dermatitis in Patients Living With HIV: A Case Series
Int. J. Dermatol 2021 Mar 04;[EPub Ahead of Print], KB Nusbaum, BH Kaffenberger, MM Paradiso Bs, JA Sopkovich, H Daou, L Seminario-Vidal, JC TrinidadFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
Human immunodeficiency virus (HIV) infection is associated with cutaneous immune dysregulation and higher rates of inflammatory skin disease. In particular, the skin of patients living with HIV (PLWH) shows a type 2 T-helper cell (Th2)–predominant immunophenotype, which is thought to underlie the increased prevalence of atopic dermatitis (AD) in this population. AD is a common chronic inflammatory skin disease associated with heterogenous clinical signs (eg, lichenification, xerosis, prurigo nodules) and symptoms (eg, itch, pain), increased rates of atopic and non-atopic comorbid health conditions, and impaired health-related quality of life. The heterogeneous presentation, varying levels of severity, numerous comorbidities, and dynamic course can make AD difficult to manage—especially among PLWH, where little is known about these aspects of AD phenotype.
Patients with moderate to severe AD often warrant systemic therapy, which can present a challenge in PLWH given the desire to avoid therapeutic immunosuppression. Dupilumab, a biologic AD therapy that targets the shared IL-4/13 receptor subunit that drives type 2 inflammation in AD, is one potentially safe and effective immunomodulatory therapy for moderate to severe AD in PLWH. In this case series consisting of 3 patients with AD and 1 patient with HIV photodermatitis (all refractory to prior treatments), the authors show that dupilumab resulted in partial or full skin clearance of lesions within 3 months, along with reduction in patient-reported itch. Over the course of 1 year, dupilumab was well-tolerated, CD4-positive T-cell counts and HIV viral load remained stable, and no serious infections were reported.
Although additional translational and prospective studies are needed to better understand unique features of AD and the longitudinal response to biologic therapy in PLWH, dupilumab appears to be an efficacious and safe option. More generally, this study highlights the true heterogeneity of AD—PLWH are one of several vulnerable populations that face an immense burden related to AD that is not well-understood. Future research studies and clinical trials should focus on specific treatment considerations among these patient groups.