Long or complicated mpox in patients with uncontrolled HIV infection
Por:
Corma-Gomez, Anais, Cabello, Alfonso, Orviz, Eva, Morante-Ruiz, Miguel, Ayerdi, Oskar, Al-Hayani, Aws, Munoz-Gomez, Ana, De Los Santos, Ignacio, Gomez-Ayerbe, Cristina, Rodrigo, David, Riestra, Sandra De la Rosa, Reus-Banuls, Sergio, Silva-Klug, Ana, Galindo, Maria Jose, Santos, Marta, Serrano-Fuentes, Miriam, Faro-Miguez, Naya, Perez-Camacho, Ines, Corona-Mata, Diana, Morano, Luis, Lopez-Ruz, Miguel Angel, Montero, Marta, Anaya-Baz, Blanca, Merino, Dolores, Castillo-Navarro, Antonia, Pineda, Juan A., Macias, Juan
Publicada:
1 mar 2024
Resumen:
To date, former research about the impact of HIV infection on mpox poor
outcomes is still limited and controversial. Therefore, the aim of this
study was to assess the impact of HIV on the clinical course of mpox, in
a large population of patients from Spain. Nationwide case-series study.
Patients from 18 Spanish hospitals, with PCR-confirmed mpox from April
27, 2022 to June 30, 2023 were included in this study. The main outcome
was the development of long or complicated (LC) mpox, defined as: (i)
duration of the clinical course >= 28 days, or; (ii) disseminated
disease, or: (iii) emergence of severe complications. One thousand eight
hundred twenty-three individuals were included. Seven hundred eighty-six
(43%) were people living with HIV (PLWH), of whom 11 (1%) had a CD4 cell
count<200 cells/mm(3) and 33 (3%) <350 cells/mm(3). HIV viral load >=
1000 cp/mL was found in 27 (3%) PLWH, none of them were on effective
ART. Fifteen (60%) PLWH with HIV-RNA >= 1000 cp/mL showed LC versus 182
(29%) PLWH with plasma HIV-RNA load<1000 copies/mL and 192 (24%)
individuals without HIV infection (p<0.001). In multivariate analysis,
adjusted by age, sex, CD4 cell counts and HIV viral load at the time of
mpox, only plasma HIV-RNA >= 1000 cp/mL was associated with a greater
risk of developing LC mpox [adjusted OR=4.06 (95% confidence interval
1.57-10.51), p=0.004]. PLWH with uncontrolled HIV infection, due to lack
of ART, are at a greater risk of developing LC mpox. Efforts should be
made to ensure HIV testing is carried out in patients with mpox and to
start ART without delay in those tested positive.
Filiaciones:
Hosp Univ Juan Ramon Jimenez, Infect Dis Unit, Huelva, Spain
Hosp Univ Virgen de la Arrixaca, Unit Internal Med, Murcia, Spain
Hosp Univ Puerto Real, Infect Dis Unit, Cadiz, Spain
Hosp Univ Politecn La Fe, Infect Dis Unit, Valencia, Spain
Hosp Univ Virgen de las Nieves, Infect Dis Unit, Granada, Spain
Hosp Univ Alvaro Cunqueiro, Infect Dis Unit, Vigo, Spain
Univ Cordoba, Dept Med, Cordoba, Spain
Maimonides Inst Biomed Res Cordoba Inst Maimonide, IMIBIC, Cordoba,
Reina Sofia Univ Hosp Cordoba, Infect Dis Unit, Cordoba, Spain
Hosp Reg Univ Malaga, Infect Dis Unit, Seville, Spain
Hosp Univ San Cecilio, Infect Dis Unit, Granada, Spain
Hosp Gran Canaria Dr Negrin, Serv Med Interna, Las Palmas Gran Canaria,
Hosp Clin Univ Valencia, Infect Dis Unit, Seville, Spain
Hosp Univ Bellvitge, Infect Dis Unit, Seville, Spain
Hosp Gen Univ Alicante, Infect Dis Unit, Seville, Spain
Univ Seville, Sch Med, Dept Med, Seville, Spain
Univ Hosp Virgen Macarena, Infect Dis & Microbiol Clin Unit, Valencia,
Consorcio Hosp Gen Valencia, Infect Dis Unit, Valencia, Spain
Hosp Univ Virgen de Victoria, Infect Dis Unit, Malaga, Spain
Spain
Hosp Univ Princesa, Serv Med Interna Enfermedades Infecciosas, Madrid,
Hosp Clin San Carlos, Ctr Sanitario Sandoval, IdISSC, Madrid, Spain
Hosp Univ Fdn Jimenez Diaz, Infect Dis Unit, Madrid, Spain
Ctr Invest Biomed Red Enfermedades Infecciosas CI, Madrid, Spain
Hosp Univ Virgen de Valme, Grp Virol Clin & ITS, Seville, Spain
CSIC, Inst Biomed Sevilla IBiS, Seville, Spain
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