Immunomodulatory Therapy in Patients Living With HIV and Inflammatory Dermatoses: A Comprehensive Review of Current Protocols and Emerging Evidence.

Despite effective antiretroviral therapy (ART), HIV infection drives progressive immune dysfunction, complicating the management of comorbid inflammatory and autoimmune dermatologic conditions such as psoriasis, atopic dermatitis, and cutaneous lupus erythematosus. These conditions often require immunomodulatory therapies, but their use in people living with HIV (PLWH) raises concerns about heightened infection risks, impacts on viral load and CD4 counts, and interactions with ART. The advent of targeted biologics, including tumor necrosis factor, interleukin (IL)-17, IL-23, and Janus kinase inhibitors, has revolutionized treatment for immune-mediated skin diseases. However, limited clinical trial data in PLWH create uncertainty about safety and efficacy. Traditional immunosuppressants such as methotrexate and cyclosporine further complicate care due to their broad immunosuppressive effects. This review synthesizes current clinical protocols, recent guideline updates, and emerging evidence on the safety and efficacy of immunomodulatory therapies in PLWH with dermatologic conditions. By providing a concise, evidence-based framework, we aim to guide dermatologists and infectious disease specialists in optimizing treatment decisions to improve dermatologic and systemic health outcomes in this complex patient population.