Study: Tecovirimat effective as early treatment for mpox in those with HIV

Key takeaways:

• People with HIV may develop more severe mpox, underscoring a need for effective treatment.
• The findings support tecovirimat use in people with HIV as soon as an mpox diagnosis is suspected, researchers said.

People with HIV who were treated with tecovirimat within the first 7 days of mpox symptom onset were 13 times less likely to progress to severe mpox disease compared with those not treated or treated late, a recent study found.

According to Bruce Aldred, MD, an assistant professor in the department of medicine at Emory University School of Medicine, and colleagues, the 2022 mpox outbreak disproportionately affected people with HIV (PWH).

“This population may develop more severe mpox disease manifestations and worse clinical outcomes, especially individuals with lower CD4 T-cell counts and nonsuppressed HIV viremia, highlighting the urgent need for effective therapeutic agents for this population,” they wrote in JAMA Internal Medicine.

Tecovirimat is available in the United States through an expanded access investigational new drug protocol for the treatment of mpox; however, “data showing the effectiveness of tecovirimat for treating mpox disease in humans are lacking,” the researchers noted.

Aldred and colleagues thus aimed to assess the impact of early tecovirimat treatment on mpox progression in PWH through a prospective matched cohort analysis. The study consisted of 112 PWH who were diagnosed with the disease from June 1 through Oct. 7 of 2022.

Among the patients, half (mean age, 35 years) received tecovirimat within 7 days of mpox symptom onset, whereas the other half (mean age, 36 years) were treated later or received no tecovirimat at all.

Mpox disease progression occurred in:

• 5.4% among those in the early tecovirimat group; and
• 26.8% in the late or no tecovirimat group (paired OR = 13; 95% CI, 1.71-99.4).

Meanwhile, the median time to mpox disease progression after the 7-day symptom onset was 22 days in the early tecovirimat group and 4 days in the late or no tecovirimat group.

The researchers highlighted several limitations, such as how the study was “inadequately powered to examine specific mpox complications or mortality.”

The small sample was also mostly composed of Black individuals (84.8%), which Alred and colleagues acknowledged may have limited generalizability to other races and ethnicities.

“Results of the present study suggest that tecovirimat treatments should be started early at the time of suspected mpox diagnosis in all PWH, especially in those with nonsuppressed HIV viremia or mucosal site involvement,” they concluded, although “additional research is needed to confirm these findings.”