Comparison of clinical course of Mpox among HIV‐negative and HIV‐positive patients: A 2022 cohort of hospitalized patients in Central Europe

Abstract

Mpox has become the most significant orthopoxviral infection among humans. Since May 2022, there has been a multicountry outbreak of mpox across six continents. Retrospective observational cohort study of 94 patients with probable or confirmed mpox of whom 86.2% were hospitalized in Hospital for Infectious Diseases in Warsaw, Poland between May 16 and October 30, 2022. Most patients were young (median age: 31, IQR: 25−43 years), predominantly (88.3%) Polish men who have sex with men exposed most commonly in Poland (82.7%), Spain (6.2%), or Germany (4.9%). The median observed mpox incubation period was 7 (IQR: 4−8) days with the median hospitalization time of 7 (range: 2−24, IQR: 5−11) days. History of sexually transmitted infections (STIs) was common in the group (previous syphilis or hepatitis C virus in 33.3% and 17.3%, respectively, 6.2% of early syphilis or gonorrhea). A significant proportion (n = 43, 45.7%) of mpox cases were people with human immunodeficiency virus (HIV), all except one were on stable and virologically effective (88.4% with HIV viral load <50 copies/mL) antiretroviral treatment. Chemsex was reported in 34.6% of hospitalized cases, more commonly among people with HIV (48.5% vs. 25.0%, p = 0.029). None of the mpox infected patients presented with advanced HIV infection. Despite the fact that 6.3% of cases presented with >50 skin lesions the course of the disease was self‐limited with no severe cases or deaths. There were no significant clinical or laboratory differences or complication rates between patients with and without HIV coinfection. Epidemiological and clinical characteristics of mpox in Poland are similar to other countries, but there were no targeted, population oriented interventions or vaccination programs. Mpox diagnosis provided an opportunity to screen and diagnose other STIs. As Central European populations, including refugees from Ukraine, are largely unvaccinated against mpox access to preventive vaccinations and antiviral therapy should be maximized.

Clinical and Epidemiological Characteristics of Mpox in HIV-Infected and Uninfected Men Who Have Sex with Men: A Retrospective Study in Lisbon

“…Thus, in similar high-income settings, there is no clear evidence that the risk factors or clinical course differ according to HIV status, except for a higher prevalence of rectal lesions at presentation among PLWH [14], which we did not find in our sample. Similarly to previous works comparing Mpox presentation in HIV patients, our findings corroborate that PLWH had similar clinical presentations to those without HIV, including indicators of more widespread disease, such as extragenital lesions and nondermatological symptoms [13,15].…”

“…The high proportion of patients on HAART is a possible explanation for the lack of differences found in the clinical and laboratory courses of Mpox. In fact, a previous work by Kowalsi et al found remarkably similar results: In a sample of 43 patients, all except one were on stable and virologically effective antiretroviral treatment (88.4% with HIV viral load < 50 copies/mL), and no significant clinical or laboratory differences or complication rates between patients with and without HIV infection were found [15]. The severity was also similar in both groups, as the disease was self-limited with no severe cases or deaths, in line with our results [15].…”

Preventing stigma against the gay community to curb mpox transmission in the Western Pacific region

“…Stigmatising the gay community increases the risk of spreading mpox, and infected people are less likely to disclose symptoms or seek care, even hide their condition for fear of being diagnosed, thus might lead to delayed access to care. Undiagnosed and untreated mpox infections may infect others through unprotected sex [ 21 ]. Stigma could hinder engaging patients in proper care and getting honest answers during contact tracing [ 22 ].…”