People with HIV, mpox not at increased risk for hospitalization unless immunosuppressed
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Key takeaways:
- Having controlled HIV does not increase the risk for hospitalization after infection with mpox.
- However, uncontrolled HIV and immunosuppression increases hospitalization risk.
People with HIV diagnosed with mpox were not at an increased risk for hospitalization unless they were immunosuppressed, according to findings presented at the International AIDS Society Conference on HIV Science.
Mpox cases occurred in 113 countries during the 2022 global outbreak, including 106 that historically had not reported the infection, according to the CDC. The United States reported more cases (more than 30,600) and deaths (45) than any other country.
“[The study] is very relevant for clinicians to be aware of when they start treating patients [who] have mpox and meanwhile also live with HIV,” Ana Hoxha, MSc, an epidemiologist at WHO, said in a press briefing. “It’s very relevant for them to know the immune status of their patient for prevention of severe outcomes.”
Hoxha and colleagues analyzed data collected from the WHO’s mpox surveillance system, including data on HIV status for 34,973 of 80,843 cases tracked by the system.
Of the 34,973 people whose HIV status was known, 48% were people living with HIV, 99% of whom were male and 92% of whom were gay or bisexual men who have sex with men (MSM), and 85% of whom were aged 18 to 44 years.
Among HIV-positive patients diagnosed with mpox, 5,023 were immunosuppressed, 735 were hospitalized, 20 were admitted to intensive care and 23 died.
Patients who were immunosuppressed and HIV-positive were twice as likely (OR = 2; 95% CI, 1.64-2.43) and patients who were immunosuppressed and HIV-negative were more than three times as likely (OR = 3.56, 95% CI, 1.8-7.01) to be hospitalized with mpox compared with HIV-negative immunocompetent patients. Living with HIV on its own did not increase the risk, the researchers said.
“The most important insight was that among mpox cases, people living with HIV were not more likely to be hospitalized unless they were significantly immunosuppressed, as evidenced by a low CD4 count,” Charles F. Gilks, MBBS, DPhil, dean of the School of Public Health at the University of Queensland, said during the briefing.
Additionally, he said the study is important because “it builds on an evidence base from far smaller cohorts that are usually national rather than global. And because it draws from WHO’s surveillance system, it therefore provides a more global picture that includes low-income countries.”
“There’s been a paucity of data on mpox infection, with or without HIV infections, from low- and middle-income countries,” Gilks added.
Hoxha said the results underlined the importance of knowing a patient’s HIV status.
“The high prevalence of HIV among mpox cases highlights the importance of HIV testing for individuals [who] do not know their status,” Hoxha said. “Mpox diagnosis therefore presents a good occasion to be screened for HIV so that they are aware of their status.”
References:
- CDC. 2022 mpox outbreak global map. https://www.cdc.gov/poxvirus/mpox/response/2022/world-map.html. Updated July 19, 2023. Accessed July 25, 2023.
- Hoxha A, et al. Abstract 3953. Presented at: International AIDS Society Conference on HIV Science; July 23-26, 2023; Brisbane, Australia.
- WHO. Surveillance, case investigation and contact tracing for mpox (monkeypox): interim guidance. https://www.who.int/publications/i/item/WHO-MPX-Surveillance-2022.4. Accessed July 24, 2023.
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Hoxha A, et al. Abstract 3953. Presented at: International AIDS Society Conference on HIV Science; July 23-26, 2023; Brisbane, Australia.
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