Psoriasis and Chronic Viral Infections (HIV, HBV, and HCV): Therapeutic Approach and Safety

Background and Objectives: Psoriasis is a chronic immune-mediated inflammatory disease that often requires long-term systemic therapy. Coexisting human immunodeficiency virus (HIV), hepatitis B virus (HBV), or hepatitis C virus (HCV) infection complicates treatment selection because clinicians must balance control of skin and joint inflammation against risks of opportunistic infection, viral replication or reactivation, hepatotoxicity, and drug interactions. Materials and Methods: This narrative review summarizes evidence from guidelines, systematic reviews, cohort studies, case series, expert recommendations, and regulatory sources. Results: In patients with suppressed HIV RNA, stable or reconstituted CD4 counts, no active opportunistic infection, and reliable follow-up, selected systemic agents, including biologics, may be considered after individualized risk assessment. In HBV infection, reactivation prevention through antiviral prophylaxis or close monitoring is central. In HCV infection, fibrosis stage, active hepatitis, drug interactions, and timing of direct-acting antivirals should guide management. Conclusions: Chronic viral infection should not be regarded as an absolute barrier to modern psoriasis therapy.