Severe form of mpox with high mortality seen in people with advanced HIV, finds study

An international collaboration of clinicians published the largest case series of mpox infection in people with advanced HIV disease in The Lancet, in which they identify a new severe form of mpox. The majority of mpox infections in the current multi-country outbreak have occurred in sexual networks of gay, bisexual and other men who have sex with men.

The SHARE-net clinicians looked at 382 people with advanced HIV disease and mpox, including 27 of the 60 people reported to have died of mpox during the multi-country outbreak. The group describes a very severe form of mpox characterised by widespread, large, necrotising skin lesions; high rates of severe infections; and, in some cases, unusual lung lesions. This form of the disease carries a 15% mortality in people with advanced HIV disease and immunosuppression. All 27 deaths occurred within this group.

The study provides evidence that the disease is behaving differently and very concerningly in people with advanced HIV disease and immunosuppression, and the authors are calling for it to be added to AIDS-defining disease definitions set by the Center for Disease Control (CDC) and WHO that are used by clinicians worldwide to guide management of people most at risk of dying from these infections.

AIDS-defining conditions are a group of conditions that are serious and life-threatening for people with advanced HIV-related disease. Adding this severe form of mpox to the existing list of AIDS-defining conditions will help healthcare professionals to protect immunocompromised people who are most at risk of dying from mpox infection. All people with mpox should be tested for HIV, and all at-risk persons with HIV and immunosuppression should be prioritised for preventive mpox vaccination and antivirals.

Reference:

Mpox in persons with advanced HIV infection: a global case series,The Lancet,doi 10.1016/S0140-6736(23)00333-1