This study investigates the intricate relationship between HIV infection and mpox, a critical area where existing literature shows disparities in severity.
The goal of the study, published in The Lancet, was to examine clinical characteristics and outcomes of mpox in individuals living with HIV and low CD4 cell counts, specifically those with CD4 counts below 350 cells per mm3.
Individuals diagnosed with HIV constituted 38% to 50% of those impacted by the multicountry mpox outbreak in 2022. The majority of the reported cases involved individuals with elevated CD4 cell counts, showing comparable outcomes to those without HIV infection. However, recent data indicate graver clinical consequences and increased mortality rates among individuals with advanced HIV.
Researchers collected data from confirmed mpox cases in individuals with HIV between May 11, 2022, and January 18, 2023, across 19 countries. Clinical presentations, complications, and causes of death were documented, with a focus on those with severe outcomes.
The study encompassed 382 cases, including 367 cisgender men, 4 cisgender women, and 10 transgender women.
Findings of the Research
Among the 382 cases, 91% were known to be living with HIV at mpox diagnosis, with 65% adherent to antiretroviral therapy (ART).
Severe complications, including necrotizing skin lesions, lung involvement, and secondary infections, were significantly more common in individuals with CD4 cell counts below 100 cells per mm3.
Of the 382 cases, 28% were hospitalized, and 25% succumbed to the infection. Notably, all deaths occurred in people with CD4 counts below 200 cells per mm3.
Immune reconstitution inflammatory syndrome to mpox was suspected in 25% of 85 individuals initiated or re-initiated on ART, and among them, 57% died. Also, three individuals showed resistance to tecovirimat.
Conclusions
This study revealed a severe necrotizing form of mpox in individuals with advanced immunosuppression, resembling an AIDS-defining condition. The findings emphasize the critical nature of advanced HIV in exacerbating mpox outcomes, leading to fulminant dermatological and systemic manifestations, often resulting in fatalities. Understanding these severe forms of mpox is vital for improved management and prevention strategies, especially in individuals with advanced HIV immunosuppression.
Source:
Mitjà, O., Alemany, A., Marks, M., Mora, J. I. L., Rodríguez-Aldama, J. C., Silva, M. S. T., Herrera, E. a. C., Crabtree-Ramírez, B., Blanco, J. L. S., Girometti, N., Mazzotta, V., Hazra, A., Silva, M., Montenegro-Idrogo, J. J., Gebo, K. A., Ghosn, J., Vázquez, M. F. P., Prado, E. M., Unigwe, U., . . . Villareal, D. (2023). Mpox in people with advanced HIV infection: a global case series. The Lancet, 401(10380), 939–949. https://doi.org/10.1016/s0140-6736(23)00273-8
