Mpox in people with advanced HIV infection: a global case series.
Journal
Lancet (London, England)
ISSN: 1474-547X
Titre abrégé: Lancet
Pays: England
ID NLM: 2985213R
Informations de publication
Date de publication:
18 03 2023
18 03 2023
Historique:
received:
17
01
2023
revised:
26
01
2023
accepted:
30
01
2023
pubmed:
25
2
2023
medline:
22
3
2023
entrez:
24
2
2023
Statut:
ppublish
Résumé
People living with HIV have accounted for 38-50% of those affected in the 2022 multicountry mpox outbreak. Most reported cases were in people who had high CD4 cell counts and similar outcomes to those without HIV. Emerging data suggest worse clinical outcomes and higher mortality in people with more advanced HIV. We describe the clinical characteristics and outcomes of mpox in a cohort of people with HIV and low CD4 cell counts (CD4 <350 cells per mm A network of clinicians from 19 countries provided data of confirmed mpox cases between May 11, 2022, and Jan 18, 2023, in people with HIV infection. Contributing centres completed deidentified structured case report sheets to include variables of interest relevant to people living with HIV and to capture more severe outcomes. We restricted this series to include only adults older than 18 years living with HIV and with a CD4 cell count of less than 350 cells per mm We included data of 382 cases: 367 cisgender men, four cisgender women, and ten transgender women. The median age of individuals included was 35 (IQR 30-43) years. At mpox diagnosis, 349 (91%) individuals were known to be living with HIV; 228 (65%) of 349 adherent to antiretroviral therapy (ART); 32 (8%) of 382 had a concurrent opportunistic illness. The median CD4 cell count was 211 (IQR 117-291) cells per mm A severe necrotising form of mpox in the context of advanced immunosuppression appears to behave like an AIDS-defining condition, with a high prevalence of fulminant dermatological and systemic manifestations and death. None.
Sections du résumé
BACKGROUND
People living with HIV have accounted for 38-50% of those affected in the 2022 multicountry mpox outbreak. Most reported cases were in people who had high CD4 cell counts and similar outcomes to those without HIV. Emerging data suggest worse clinical outcomes and higher mortality in people with more advanced HIV. We describe the clinical characteristics and outcomes of mpox in a cohort of people with HIV and low CD4 cell counts (CD4 <350 cells per mm
METHODS
A network of clinicians from 19 countries provided data of confirmed mpox cases between May 11, 2022, and Jan 18, 2023, in people with HIV infection. Contributing centres completed deidentified structured case report sheets to include variables of interest relevant to people living with HIV and to capture more severe outcomes. We restricted this series to include only adults older than 18 years living with HIV and with a CD4 cell count of less than 350 cells per mm
FINDINGS
We included data of 382 cases: 367 cisgender men, four cisgender women, and ten transgender women. The median age of individuals included was 35 (IQR 30-43) years. At mpox diagnosis, 349 (91%) individuals were known to be living with HIV; 228 (65%) of 349 adherent to antiretroviral therapy (ART); 32 (8%) of 382 had a concurrent opportunistic illness. The median CD4 cell count was 211 (IQR 117-291) cells per mm
INTERPRETATION
A severe necrotising form of mpox in the context of advanced immunosuppression appears to behave like an AIDS-defining condition, with a high prevalence of fulminant dermatological and systemic manifestations and death.
FUNDING
None.
Identifiants
pubmed: 36828001
pii: S0140-6736(23)00273-8
doi: 10.1016/S0140-6736(23)00273-8
pii:
doi:
Types de publication
Case Reports
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
939-949Investigateurs
Viviana Leiro
(V)
Lucila Marchetta
(L)
Patricia Fernandez Pardal
(P)
María Inés Figueroa
(MI)
Pedro Cahn
(P)
Katharina Grabmeier-Pfistershammer
(K)
Agnes Libois
(A)
Laurens Liesenborghs
(L)
Beatriz Grinsztejn
(B)
Mauro Schechter
(M)
Alberto Dos Santos de Lemos
(A)
Alvaro Furtado Costa
(A)
Simone Queiroz Rocha
(S)
José Valdez Madruga
(J)
Darrell H S Tan
(DH)
Sharmistha Mishra
(S)
Shreya Shah
(S)
Camila Jorquera
(C)
Alberto Castillo
(A)
Mauricio Carrión
(M)
Nelson Cevallos
(N)
Romain Palich
(R)
Valerie Pourcher
(V)
Emma Rubenstein
(E)
Pascal Migaud
(P)
Christoph Boesecke
(C)
Christian Hoffmann
(C)
Konstantinos Protopapas
(K)
Silvia Nozza
(S)
Anna Maria Cattelan
(AM)
Cristina Mussini
(C)
Antonella d'Arminio Monforte
(A)
Raúl Adrian Cruz Flores
(RA)
Edgar Pérez Barragán
(E)
Alma Leticia Rodríguez Guzmán
(AL)
Dimie Ogoina
(D)
Nneka Marian Chika-Igwenyi
(NM)
Onyeaghala Chizaram
(O)
Jenny Valverde López
(J)
Angelica García Tello
(A)
Maria Ubals
(M)
Martí Vall
(M)
Adrià Mendoza
(A)
Clara Suñer
(C)
Bonaventura Clotet
(B)
Jordi Bechini
(J)
Jose A Lepe
(JA)
M Dolores Navarro-Amuedo
(MD)
Jose Ignacio Bernadino
(JI)
Alba Català
(A)
Eloy José Tarín Vicente
(EJ)
Borja González Rodríguez
(B)
Sergi Rodriguez-Mercader
(S)
Francisca Sánchez-Martinez
(F)
Esperanza Cañas-Ruano
(E)
Laura Parra-Navarro
(L)
Finn Filén
(F)
Carmen Tallón de Lara
(C)
Dominique Braun
(D)
Vanja Piezzi
(V)
Michael Burkhard
(M)
Helen Kovari
(H)
Anja Mönch
(A)
Jake Dunning
(J)
Pedro Simoes
(P)
Achyuta Nori
(A)
Sarah Keegan
(S)
John P Thornhill
(JP)
Vanessa Apea
(V)
Teymur Noori
(T)
Joyce L Jones
(JL)
Seth Judson
(S)
Elizabeth A Gilliams
(EA)
Matthew M Hamill
(MM)
Jeanne Keruly
(J)
Andrés F Henao Martínez
(AF)
Aung Lin
(A)
Jessica So
(J)
Kusha Davar
(K)
Diana Villareal
(D)
Miguel Tapia Paredes
(M)
Commentaires et corrections
Type : CommentIn
Type : ErratumIn
Type : CommentIn
Type : CommentIn
Informations de copyright
Copyright © 2023 Elsevier Ltd. All rights reserved.
Déclaration de conflit d'intérêts
Declaration of interests We declare no competing interests.