Intersecting HIV and mpox epidemics: more questions than answers

Girometti, Nicolò; Ogoina, Dimie; Tan, Darrell H. S.; Pozniak, Anton; Klein, Marina B.

doi:10.1002/jia2.26043

Cited by 11 publications

(11 citation statements)

References 14 publications

(27 reference statements)

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“…This cohort had 78% with a CD4 + cell count >350 cells/mm 3 and 82% with an undetectable HIV viral load. Hospitalization among PWH was more common in those with detectable viral loads and CD4 + cell count <350 cells/mm 3 , although rectal symptoms were not related to degree of immunosuppression [14 ▪▪ ,21,31 ▪▪ ,38–41].…”

Section: Clinical Presentation and Severitymentioning

confidence: 95%

Mpox in people living with HIV

Maan,

Kohli,

Gilson

2023

Current Opinion in Infectious Diseases

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Purpose of review The 2022 global outbreak of mpox disproportionally affected people with HIV (PWH). We review the data on the presentation, treatment, and prevention of mpox in PWH. Recent findings Most PWH with mpox had a mild and self-limiting illness, no different to people without HIV. A higher rate of rectal symptoms has been reported among PWH and those with advanced HIV disease were at higher risk of severe disease, hospitalization, and death. Treatment with antivirals was widely used in hospitalized patients without any randomized control trial data to support its use and without any data specifically in PWH. Use of smallpox vaccines to prevent mpox is safe in PWH regardless of CD4+ cell count. There is limited data on efficacy in those with lower CD4+ cell count and on long-term protective efficacy. Summary PWH should be offered vaccination against mpox in line with national guidelines. PWH should be individually risk-assessed for severe mpox, based on their CD4+ cell count and co-morbidities and ideally recruited into treatment trials to build an evidence base on efficacy. HIV and other sexually transmitted infection testing should be offered to all people diagnosed with mpox.

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Section: Clinical Presentation and Severitymentioning

confidence: 95%

Mpox in people living with HIV

Maan,

Kohli,

Gilson

2023

Current Opinion in Infectious Diseases

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“…Previously, it has been suggested that the overrepresentation of PWH among mpox cases could be due to a relationship with sexually transmitted infections (STIs) or through increased encounters with the healthcare system leading to increased testing [ 9 ]. Although mpox is not currently classified as an STI, transmission of the virus in the 2022 outbreak has primarily occurred through sexual networks [ 3 , 10 , 11 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

“…PWH may also be more likely to be diagnosed with mpox due to increased encounters with the healthcare system [ 9 ]. Most rashes appear in hard-to-see locations, such as the genital and anorectal regions [ 15 , 16 ].…”

Section: Introductionmentioning

confidence: 99%

Characterizing Indicators of Engagement in HIV-Associated Healthcare and Clinical Outcomes among People with HIV and Mpox in Washington, DC: A Nested Case-Control Study of the DC Cohort

O’Connor,

Byrne,

Baskaran

et al. 2024

Pathogens

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The high proportion of people with HIV (PWH) in the 2022–2023 mpox outbreak has raised questions surrounding the association between HIV and mpox. The objectives of this study were to evaluate the association between engagement in HIV-associated healthcare and mpox diagnosis, as well as to characterize cases of mpox among PWH. The DC Cohort is a longitudinal cohort of PWH in Washington, DC. We conducted a 5:1 (controls:cases) nested case-cohort study on male participants, matching age and care site. Cases were participants with an identified mpox diagnosis. Conditional logistic regression was used to assess the impact of indicators of engagement in HIV-associated healthcare on mpox diagnosis. We identified 70 cases of mpox in DC Cohort participants randomly matched to 323 controls, for a total of 393 participants included in the analysis. Study participants were primarily non-Hispanic Black (72.3%) with a median age of 41 (IQR: 36, 50). There was no association between engagement in care and mpox diagnosis; however, low CD4 was associated with increased odds of mpox diagnosis (aOR: 4.60 (95% CI: 1.23, 17.11)). Among a cohort of PWH, engagement in care was not associated with mpox diagnosis, suggesting that the overrepresentation of PWH among mpox cases is not due to surveillance bias.

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“…The 2022 multinational mpox outbreak in nonendemic countries led to its declaration as a health emergency in July 2022, reaching the global number of 90 618 cases and 157 deaths by 27 September 2023, with Brazil being the second most affected country [1,2]. Cisgender MSM were disproportionately burdened by this outbreak; 30-50% of individuals diagnosed with mpox were living with HIV [3][4][5][6][7][8][9][10][11]. Generally, people with HIV (PWH) and mpox were older and more often presented with concomitant sexually transmitted infections (STIs), anogenital lesions and proctitis [4,8,9,12].…”

Section: Introductionmentioning

confidence: 99%

Mpox severity and associated hospitalizations among people with HIV and related immunosuppression in Brazil

Silva,

Coutinho,

Torres

et al. 2023

Aids

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Objectives: This study aimed to analyze characteristics of mpox hospitalization in a Brazilian cohort, further exploring the impact of HIV on mpox-related outcomes and hospitalization. Design: We conducted a descriptive analysis, comparing characteristics of individuals diagnosed with mpox according to hospitalization and HIV status, and described the mpox cases among those living with HIV. Methods: This was a single-center, prospective cohort study conducted at a major infectious diseases referral center in Rio de Janeiro, Brazil, that enrolled participants older than 18 years of age diagnosed with mpox. Information was collected on standardized forms, including data on sociodemographic, behavioral, clinical and laboratory characteristics. For comparisons we used chi-squared, Fisher's exact and the Moods median tests when appropriate. Results: From June to December, 2022, we enrolled 418 individuals diagnosed with mpox, of whom 52% were people living with HIV (PLHIV). PLHIV presented more frequently with fever, anogenital lesions and proctitis. The overall hospitalization rate was 10.5% (n = 43), especially for pain control. Among hospitalized participants, PLHIV had more proctitis and required invasive support. Mpox severity was related to poor HIV continuum of care outcomes and low CD4+ cell counts. All deaths (n = 2) occurred in PLHIV with CD4+<50 cells/mm3. Conclusions: HIV-related immunossupression likely impacts mpox clinical outcomes. This is of special concern in settings of poor adherence and late presentation to care related to socioeconomic inequalities, such as Brazil. The HIV continuum of care must be taken into account when responding to the mpox outbreak.

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Intersecting HIV and mpox epidemics: more questions than answers

Cited by 11 publications

References 14 publications

Mpox in people living with HIV

Mpox in people living with HIV

Characterizing Indicators of Engagement in HIV-Associated Healthcare and Clinical Outcomes among People with HIV and Mpox in Washington, DC: A Nested Case-Control Study of the DC Cohort

Mpox severity and associated hospitalizations among people with HIV and related immunosuppression in Brazil

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