Oral Glucocorticoids and Antiretroviral Therapy Controlled Severe HIV-Linked Psoriasis in One Case

A 37-year-old Japanese man with severe, treatment-resistant psoriasis saw his skin disease improve markedly after receiving oral glucocorticoids for a concurrent lung infection, followed by antiretroviral therapy, according to a case report published in AIDS Research and Therapy on 10 October 2026. The report suggests that systemic glucocorticoids, when required for another condition, may provide temporary control of severe HIV-associated psoriasis until antiretroviral therapy can begin.

Psoriasis can be a presenting manifestation of HIV infection, and HIV-associated psoriasis is often severe and resistant to treatment. Systemic glucocorticoids are generally discouraged in this setting because of concerns that they may exacerbate psoriasis and cause infectious complications. The authors note that their efficacy and safety in the era of combination antiretroviral therapy remain unclear, which is why a single well-documented case can add to the clinical conversation.

The man presented with widespread psoriasis that had not responded to topical therapy. His Psoriasis Area and Severity Index score, a standard measure of disease extent and severity, was 14.2. During the same evaluation he was newly diagnosed with HIV-1 infection, with a serum HIV-1 RNA level of 690,000 copies per milliliter and a CD4-positive T-cell count of 102 cells per microliter, indicating substantial immune suppression.

Before antiretroviral therapy could be started, he developed Pneumocystis jirovecii pneumonia, a serious opportunistic infection, and was hospitalized. Treatment with trimethoprim-sulfamethoxazole was initiated for the pneumonia, but his fever persisted. clinicians therefore added prednisolone at a dose of 30 milligrams per day.

The response was prompt. His fever resolved quickly, and his psoriatic skin lesions also showed marked improvement while he was taking the corticosteroid. This outcome is notable because oral glucocorticoids are usually avoided in psoriasis over fears of flaring, yet in this patient the skin disease improved rather than worsened.

Once the pneumonia was being controlled, antiretroviral therapy with bictegravir, emtricitabine and tenofovir alafenamide was initiated. The prednisolone was then gradually tapered and discontinued over five months. Psoriasis remained in remission throughout this period, with no recurrence of the skin disease and no development of new opportunistic infections.

The authors conclude that this case suggests systemic glucocorticoids, when required for a concomitant condition, may provide temporary control of severe HIV-associated psoriasis until antiretroviral therapy initiation.

As a single case report, the findings carry clear limitations. One patient’s course cannot establish how often glucocorticoids would help or harm other people with HIV-associated psoriasis, and the authors themselves note that the efficacy and safety of systemic glucocorticoids in the current treatment era remain unresolved. The observation is best read as a signal for careful clinical judgment rather than a treatment recommendation.

Subject of Research: Treatment of severe HIV-associated psoriasis with systemic glucocorticoids and antiretroviral therapy

Article Title: Severe HIV-associated psoriasis successfully treated with oral glucocorticoids and antiretroviral therapy: a case report

Article References: Horimoto, E., Suemori, K., Horie, K., Tsuboi, S., Yatsuzuka, K., & Takenaka, K. (2026). Severe HIV-associated psoriasis successfully treated with oral glucocorticoids and antiretroviral therapy: a case report. AIDS Research and Therapy. https://doi.org/10.1186/s12981-026-00964-4

Image Credits: AI Generated

DOI: 10.1186/s12981-026-00964-4

Keywords: HIV, psoriasis, glucocorticoids, prednisolone, antiretroviral therapy, case report, Pneumocystis jirovecii pneumonia, CD4 count, AIDS Research and Therapy, opportunistic infection, Severe, HIV-associated