Etanercept for the treatment of human immunodeficiency virus-associated psoriatic arthritis

Etanercept may play an important role in modulating the inflammatory activi ty and progression of human immunodeficiency virus (HIV)-associated psorias is and psoriatic arthritis. We report the case of a 45-year-old homosexual man with a CD4 cell count of less than 0.05 x 10(9)/L and an HIV viral load of 4200 copies/ml (while receiving,highly active antiretroviral therapy) w ho developed extensive psoriatic plaques, 4.5-kg weight loss, onychodystrop hy, and psoriatic arthropathy with severe periarticular bone demineralizati on, The arthritis progressed despite the use of several disease-modifying m edications, including corticosteroids, hydroxychloroquine, and minocycline. Because of uncontrolled, progressive, and disabling arthritis and resultin g profound disability, he was treated with etanercept, Within 3 weeks, his psoriasis had improved dramatically and his joint inflammation had stabiliz ed. For the next 4 months, immunologic and viral parameters remained stable , but his clinical course was complicated by frequent polymicrobial infecti ons. Etanercept was thus discontinued despite continued improvements in his psoriasis, psoriatic arthritis, and functional status. While both cutaneou s and joint manifestations of psoriasis improved dramatically, the experien ce with this patient dictates that caution and careful follow-up must be ex ercised when prescribing etanercept in the setting of HIV infection.