In May 2022, the world discovers monkeypox in a British patient who returned from Nigeria. Quickly, cases are multiplying in Europe and the United States. The epidemic was declared on July 23, 2022 by the World Health Organization, before subsiding at the end of the year. Disease – since mpox fame – has mainly affected men who have sex with other men, among whom the proportion of people infected with HIV is higher.
But what are the risks in a patient infected with both HIV and mpox? A study published on February 21, 2023 in the Lancet identified a very severe form of the disease, which they called “fulminating mpoxand which focuses on patients with advanced HIV infection. “A severe, necrotizing form of mpox (could) resemble an AIDS-defining disease“, summarized the authors. It is manifested by massive necrosis of the skin, the genitals and sometimes the lungs and is fatal in about 15% of cases.
Our global case series on MPOX in people with advanced HIV infection is at #CROI2023 and in @TheLancet today: 382 cases of human MPOX infection in PLWH with CD4 counts <350 cells/mm3 in 19 countries
**We found MPOX is an opportunistic pathogen** /1https://t.co/WodDN4Ujojpic.twitter.com/IlK7viABmy— Chloe Orkin (@profchloeorkin) February 21, 2023
“The virus seems to behave completely differently in these individualssaid Pr Chloe Orkin, head of the study. Normally the disease affects the area around the site of entry, but in this case it spreads throughout the body and causes these massive and destructive ulcerative skin lesions. It also causes lung diseases. It’s horrible.”
Nearly 400 patients infected with mpox and HIV were studied: among them, 27 patients died. All had less than 200 CD4 T cells per mm3 of blood, the threshold usually used to speak of AIDS, which shows a weakening of the immune system. This number of deaths is high compared to the total number of deaths caused by the epidemic since its beginning: as of February 21, 2023, 96 deaths have been confirmed by WHO (and 86,019 cases across 110 countries worldwide).
Call for vaccination
As a first step, the researchers call for encouraging vaccination as a priority for people with HIV, especially in countries where diagnosis rates are low, and not forgetting that, despite the significant drop in cases, we must not forget this means of prevention. “It’s also a reminder that it’s not too late to get vaccinated with the first and second doses available at sexual health clinics, and two doses offering maximum protection against the virus.“, inform the researchers.
They are asking to add this severe form of mpox to the list of illnesses characteristic of AIDSwhich today includes about fifteen diseases considered dangerous in the event of advanced HIV infection, in particular tuberculosis, cryptococcal meningitis or even certain bacterial infections.
Source :
- Mpox in people with advanced HIV infection: a global case, The LancetFebruary 21, 2023
