Epidemiologic and Clinical Features of Mpox-Associated Deaths — United States, May 10, 2022–March 7, 2023

Abstract

us-map.html (Accessed March 20, 2023). § Among mpox-associated deaths (38), data on gender identity was available for 28 (73.7%) decedents. For 10 (26.3%) persons for whom self-reported gender was missing, sex assigned at birth was substituted for gender identity. ¶ Case counts include those who received a positive test result for either Monkeypox virus or orthopoxvirus. ** https://www.cdc.gov/nndss/index.html (Accessed March 20, 2023).

Optimal management of severe mpox in patients with uncontrolled human immunodeficiency virus

“…Among the largest cohorts, mortality rates in patients with advanced HIV range from 15% to 40% 5,7 . Death occurs many weeks to months after the initial presentation 5,7,23,27,29,30,34,36 . These reports also highlight the phenomenon of IRIS, described as an acute worsening or spreading of a patient's lesions and clinical deterioration approximately 2 weeks after initiation of ART 5,27,29,36 .…”

“…Based on the heterogeneity of published cases, it is not clear if this progression represents the natural course of the disease in severely immunosuppressed hosts, or if there is a true development of IRIS. In the limited data available, there does not appear to be a significant difference in outcome among those who received IRIS treatment and those who did not; nor does there appear to be any benefit to delaying ART initiation 5,27,29 . Therapies targeted at IRIS include corticosteroids and may be considered at the provider's discretion. …”

“…Death occurs many weeks to months after the initial presentation 5,7,23,27,29,30,34,36 . These reports also highlight the phenomenon of IRIS, described as an acute worsening or spreading of a patient's lesions and clinical deterioration approximately 2 weeks after initiation of ART 5,27,29,36 . At this time, it is not clear if these cases represent true IRIS, or simply the natural progression of mpox in severely immunosuppressed patients.…”

“…">ART should be initiated as soon as feasible, and in accordance with other HIV management guidance. While data are scarce, there appears to be no benefit to delaying ART to attenuate possible IRIS 5,27,29,36 …”

Health inequities continue to drive the public health threat of mpox

“…Several reports from the US and globally have found that many patients who have died of mpox during this outbreak also had advanced HIV 3,4,5,6. The covid-19 pandemic disrupted HIV/AIDS care globally, creating a particularly challenging set of conditions just before the mpox outbreak emerged 7.…”