The mpox virus -- formerly known as monkeypox -- often causes severe illness and death in those with advanced HIV infection that is not under control, researchers report.
What does that mean? All people diagnosed with mpox should also be tested for HIV, the investigators said.
The international collaboration of scientists also recommends that the World Health Organization and the U.S. Centers for Disease Control and Prevention add this strain of mpox to its list of severe infections considered particularly dangerous to people with advanced HIV disease.
“Currently, there is a list of fourteen infections which behave differently and are particularly dangerous to immunosuppressed people with advanced HIV infection. These are called ‘AIDS-defining conditions' by international public health agencies. Clinicians worldwide use this classification to guide their management of people most at risk of dying from these infections,” lead author Chloe Orkin, a professor of HIV medicine at Queen Mary University of London, explained in a university news release.
The data highlight the fact that mpox remains a significant threat to people with advanced HIV, said Matthew Hodson, executive director of NAM aidsmap.
“Although mpox is rarely severe for those of us whose HIV is controlled with treatment, the rates of serious illness and mortality as a result of mpox for people with untreated or unsuppressed HIV are worrying,” Hodson said. “This again highlights the urgency of ensuring people with HIV are diagnosed and have secure access to treatment. Routine HIV testing for all people diagnosed with mpox has the potential to reduce mpox-related deaths and advanced HIV disease.”
The mpox outbreak that spread around the world last year was linked to networks of gay, bisexual and other men who have sex with men, according to the study.
Researchers estimated that between 38% and 50% of people diagnosed with mpox in the 2022 outbreak also had HIV. Most, however, were on HIV treatment and living healthy lives, the study noted.
In this study, clinicians looked at 382 people who had advanced HIV disease and mpox. This included 27 of the 60 people who died of mpox during the outbreak.
This latest strain of mpox includes widespread necrotizing skin lesions. There are also high rates of severe infections. In some cases, patients have had unusual lung lesions.
"We describe a severe form of mpox affecting mostly young men who have sex with men and which results in death in 15% of people with advanced HIV,” said study first author Oriol Mitjà, an associate professor of infectious disease and global health at the Fight Infectious Diseases Foundation.
“When clinicians recognize necrotizing skin lesions and/or lung involvement, they should use a differentiated clinical pathway and an intensified approach," Mitjà said. "Also, health authorities should prioritize the vaccination of people living with HIV, particularly in countries with low levels of diagnosis or without universal free access to antiretroviral treatment."
In addition to testing all people with mpox for HIV, all at-risk persons with HIV and immunosuppression should be prioritized for mpox vaccination and antivirals, the researchers said.
Study findings were published Feb. 21 in The Lancet journal.
The World Health Organization has more on mpox.
SOURCE: Queen Mary University of London, news release, Feb. 21, 2023