The <scp>u</scp>se of Vaccinia Immune Globulin in the Treatment of Severe Mpox. Virus Infection in Human Immunodeficiency Virus/AIDS

Thet, Andrea K; Kelly, Paul J.; Kasule, Sabirah N; Shah, Anish; Chawala, Arpan; Latif, Amber; Chilimuri, Sridhar; Zeana, Cosmina B

doi:10.1093/cid/ciac971

Cited by 16 publications

(9 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…He also received HAART with improvement of his T‐cell count and reduction of his viral load. A similar case was reported in which a patient with HIV‐AIDS had an identical course of progression and required VIGIV for treatment 37 …”

Section: Discussionsupporting

confidence: 57%

Severe soft tissue infection: A complication of mpox in an individual with HIV coinfection requiring vaccinia intravenous immunoglobulin and intravenous tecovirimat

Mahtani,

Seelam,

Padda

et al. 2023

Journal of Medical Virology

View full text Add to dashboard Cite

We highlight a case of a 38-year-old immunocompromised man with untreated human immunodeficiency virus and Hepatitis C who presented with progressive soft tissue infection of the right foot despite appropriate antibiotic therapy. While he was admitted, the patient disclosed a recent diagnosis of mpox treated with oral tecovirimat. He subsequently developed worsening lesions over his entire body. In addition, a polymerase chain reaction of the wound on the right foot was positive for mpox virus, and the patient improved on treatment with intravenous tecovirimat and vaccinia immunoglobulin.

show abstract

Section: Discussionsupporting

confidence: 57%

Severe soft tissue infection: A complication of mpox in an individual with HIV coinfection requiring vaccinia intravenous immunoglobulin and intravenous tecovirimat

Mahtani,

Seelam,

Padda

et al. 2023

Journal of Medical Virology

View full text Add to dashboard Cite

show abstract

“…Vaccinia immune globulin was also provided by the CDC around the same time. A case report was recently published about a man with AIDS who did not respond to tecovirimat but instead showed clinical improvement after Vaccinia immune globulin was added for the treatment of refractory mpox [ 45 ]. It is unclear whether our patient’s clinical response was due to Cidofovir or Vaccinia treatment, or both since they were administered only 2 days apart.…”

Section: Discussionmentioning

confidence: 99%

Successful Outcome after Treatment with Cidofovir, Vaccinia, and Extended Course of Tecovirimat in a Newly-Diagnosed HIV Patient with Severe Mpox: A Case Report

Martinez

Frattaroli

et al. 2023

Vaccines

View full text Add to dashboard Cite

Purpose: To report a case of severe mpox in a newly diagnosed HIV patient concerning Immune Reconstitution Inflammatory Syndrome (IRIS) and/or tecovirimat resistance and/or tecovirimat resistance and to describe the management approach in the setting of refractory disease. Case: 49-year-old man presented with 2 weeks of perianal lesions. He tested positive for mpox PCR in the emergency room and was discharged home with quarantine instructions. Three weeks later, the patient returned with disseminated firm, nodular lesions in the face, neck, scalp, mouth, chest, back, legs, arms, and rectum, with worsening pain and purulent drainage from the rectum. The patient reported being on 3 days of tecovirimat treatment, which was prescribed by the Florida department of health (DOH). During this admission, he was found to be HIV positive. A pelvic CT scan revealed a 2.5 cm perirectal abscess. Treatment with tecovirimat was continued for 14 days, along with an empiric course of antibiotics for treatment of possible superimposed bacterial infection upon discharge. He was seen in the outpatient clinic and initiated antiretroviral therapy (ART) with TAF/emtricitabine/bictegravir. Two weeks after starting ART, the patient was readmitted for worsening mpox rash and rectal pain. Urine PCR also returned positive for chlamydia, for which the patient was prescribed doxycycline. He was discharged on a second course of tecovirimat and antibiotic therapy. Ten days later, the patient was readmitted for the second time due to worsening symptoms and blockage of the nasal airway from progressing lesions. At this point, there were concerns for tecovirimat resistance, and after discussion with CDC, tecovirimat was reinitiated for the third time, with the addition of Cidofovir and Vaccinia, and showed an improvement in his symptoms. He received three doses of cidofovir and two doses of Vaccinia, and the patient was then discharged to complete 30 days of tecovirimat. Outpatient follow-up showed favorable outcomes and near resolution. Conclusion: We reported a challenging case of worsening mpox after Tecovirimat treatment in the setting of new HIV and ART initiation concerning IRIS vs. Tecovirimat resistance. Clinicians should consider the risk of IRIS and weigh the pros and cons of initiating or delaying ART. In patients not responding to first-line treatment with tecovirimat, resistance testing should be performed, and alternative options should be considered. Future research is needed to establish guidance on the role of Cidofovir and Vaccinia immune globulin and the continuation of tecovirimat for refractory mpox.

show abstract

“…Vaccinia immune globulin (VIG) is licensed in the USA for the treatment of severe vaccinia [64]. Vaccines used to combat smallpox and mpox are based on vaccinia and rely on the cross reactivity of the immune response.…”

Section: Treatmentmentioning

confidence: 99%

“…It is given intravenously as a single dose but can be repeated. Animal studies showed VIG had activity against other orthopoxviruses in immunosuppressed and immune competent animals [64]. Ahmed et al found that 2022 MPXV isolates had 84% genetic similarity to vaccinia and that immune responses generated from vaccinia-based vaccine were cross-reactive with MPXV [65].…”

Section: Treatmentmentioning

confidence: 99%

Mpox in people living with HIV

Maan,

Kohli,

Gilson

2023

Current Opinion in Infectious Diseases

View full text Add to dashboard Cite

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.

show abstract

The use of Vaccinia Immune Globulin in the Treatment of Severe Mpox. Virus Infection in Human Immunodeficiency Virus/AIDS

Cited by 16 publications

References 8 publications

Severe soft tissue infection: A complication of mpox in an individual with HIV coinfection requiring vaccinia intravenous immunoglobulin and intravenous tecovirimat

Severe soft tissue infection: A complication of mpox in an individual with HIV coinfection requiring vaccinia intravenous immunoglobulin and intravenous tecovirimat

Successful Outcome after Treatment with Cidofovir, Vaccinia, and Extended Course of Tecovirimat in a Newly-Diagnosed HIV Patient with Severe Mpox: A Case Report

Mpox in people living with HIV

Contact Info

Product

Resources

About