Secukinumab for the treatment of a severe psoriasis associated with HIV infection.

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ARTICLE TITLE Treatment of a patient with severe psoriasis associated with HIV infection with secukinumab. RELEVANCE Psoriasis is a chronic disease of multifactorial origin with a dominant role in the development of genetic factors, characterized by accelerated proliferation of keratinocytes and impaired differentiation, an imbalance between pro-inflammatory and anti-inflammatory cytokines, with frequent pathological changes in the musculoskeletal system [1, 2]. Psoriasis is one of the most common skin diseases and, according to literary data, occurs in 1-2% of the population of countries [2]. According to official state statistics, in the Russian Federation, the prevalence of psoriasis in 2022 is 253.0 diseases per 100 thousand population, in 2023 it is 257.7 diseases per 100 thousand population; The incidence rate in 2022 is 64.2 per 100 thousand population, in 2023 64.7 per 100 thousand population [3, 4]. In the Kemerovo region, the prevalence of psoriasis in 2022 is 390.4 diseases per 100 thousand population, in 2023 - 293.5 diseases per 100 thousand population; the incidence rate in 2022 is 71.1 per 100 thousand population, in 2023 - 103.5 per 100 thousand population [4]. Statistics show that the incidence and prevalence of psoriasis in the Kemerovo region is higher than in the Russian Federation. Hereditary predisposition, dysfunctions of the immune, endocrine, nervous systems, and adverse effects of environmental factors are important in the development of psoriasis. The provoking factors include psychoemotional stress, chronic infections (usually streptococcal), alcohol abuse, chloroquine/hydroxychloroquine**, hormonal oral contraceptives, interferons, other immunostimulants, etc.). Also, one of such triggers in the debut of psoriasis is HIV [9, 11]. Very often, the first manifestations of psoriasis occur against the background of HIV infection in people who do not receive effective antiretroviral therapy, or against its background [9, 11]. Clinical manifestations of psoriasis can vary from mild to severe at any stage of HIV infection. It is noted that one patient can have symptoms of various clinical forms of psoriasis at the same time. Most often, people with HIV infection have a course of psoriasis that is difficult to treat [9]. Since local therapy is most often effective for mild to moderate psoriasis, and some systemic drugs suppress the immune system, the indication for the treatment of severe forms of psoriasis is GEBD [2, 5]. Genetically engineered biological drugs (GEBD) are drugs based on protein molecules created using genetic engineering methods. GEBD have a targeted effect on areas of the immune system that are responsible for pathological processes by blocking cytokines or receptors through which cytokines bind to the cell [6]. The drugs also inhibit pathological activation of B and T lymphocytes, but do not affect the functioning of the entire immune system. One of such drugs in the treatment of severe forms of psoriasis is secukinumab [7-13]. This drug is registered in Russia and belongs to the group of IL-17A inhibitors [7-13]. According to clinical guidelines, secukinumab has a recommendation strength level of A (evidence level of 2) [2]. Clinical studies of secukinumab have shown that it provides a rapid onset of clinical effect with a decrease in the severity of inflammation and infiltration of psoriatic plaques already in the third week of treatment, and in patients with psoriatic arthritis, the clinical effect is observed after the first week of treatment [6]. CASE DESCRIPTION Patient V., born in 1986, has been observed at the Kuzbass Clinical Skin and Venereal Diseases Dispensary KDO1 since 2018. Considers himself ill since 2010, when he first began to notice skin rashes. He did not consult a doctor, treated himself with external hormonal drugs, and noted a deterioration during treatment. In the same year, the patient was diagnosed with Ds: HIV infection. He contacted the AIDS center, antiretroviral therapy was prescribed. Against the background of antiretroviral therapy, the skin condition improved. Since 2018, a significant deterioration in the skin process is associated with receiving new therapy for the treatment of HIV infection. He contacted a dermatologist at the Skin and Venereal Diseases Dispensary with complaints of rashes on the skin of the trunk, upper and lower extremities, scalp, moderate itching. During the examination, Ds was assigned: Psoriasis vulgaris, newly diagnosed, widespread, with lesions of the scalp, progressive stage, PASI> 11, DLQI-14. Received treatment: external hormonal drugs + salicylic ointment, courses of inpatient treatment, against the background of which he noted positive dynamics. In 2022, he began to notice joint pain, contacted a rheumatologist, was assigned Ds: Psoriatic arthritis, spondyloarthritis, bilateral sacroiliitis. In 2023, he again contacted a dermatologist with complaints of deterioration of the skin condition, pain in the

About the authors

Ksenia Andreevna Dyachenko

Author for correspondence.
Email: antipova.kseniya@mail.ru
ORCID iD: 0009-0001-6429-2650

врач - дерматовенеролог, ассистент кафедры "дерматовенерологии и косметологии"

Olga Evgenievna Ianets

Email: janetso@bk.ru
ORCID iD: 0009-0002-5005-7649
SPIN-code: 7700-8453

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