They discover a serious form of Mpox that would be lethal in people with HIV

They discover that the people with HIV advanced can develop a very serious form of viruela del mono or Mpox; Specifically, researchers have found that Mpox behaves like “a different disease” in individuals with a depressed immune systemso that monkeypox constitutes a deadly risk for untreated HIV patients.

Monkeypox cases have fallen worldwide, but the World Health Organization (WHO) confirmed last week that it continues to be a global emergency, and now an international team of scientists led by the Foundation Fights Infections ( FLI) of the Germans Trias i Pujol Hospital in Barcelona and Queen Mary University of London, has identified a severe, necrotizing form of Mpox that causes the death of 15% of people with advanced HIV who are immunosuppressed, according to research published in The Lancet.

The current outbreak began in May 2022 and since then around 85,000 cases have been detected worldwide, the vast majority in gay, bisexual, or men who have sex with men. The main route by which the disease is contracted is close physical contact during sexual intercourse. as you explained Oriol MitjaFLI infectious disease specialist, men with HIV and those who take antiretroviral drugs daily to avoid becoming infected with HIV by having sex without a condom – known as pre-exposure prophylaxis (PrEP) – are the population groups with the highest risk of becoming infected. with Mpox.

Skin and lung lesions in people with HIV and Mpox

In the new research, data from 382 individuals with advanced HIV (all men except 10 transgender women and 4 cisgender women) have been analyzed, of whom 107 were hospitalized and 27 died. The analysis has made it possible to identify a very severe form of Mpox that is characterized by necrotizing skin lesionslarge and widespread, high rates of serious infections and, in some cases, lung injuries infrequent, and which carries a mortality of 15% in patients with advanced HIV disease and immunosuppressed.

In fact, the 27 deaths occurred in a group made up of 179 immunosuppressed patients who had less than 200 CD4 cells per microliter (over 500 is considered normal), and the study found that in people with few CD4 cells, Mpox skin lesions that were usually small developed into large necrotizing patches and their infection sometimes spread to the lungs or provoked serious secondary infections with bacteria.

“Every person with Mpox should have an HIV test. And all people with HIV and Mpox should take a test to measure their defenses”

The study authors have requested that this severe form of Mpox be included in the list of AIDS-defining illnesses, which lists 14 infections that act in different ways and are more dangerous in people with advanced HIV. Dr. Chloe Orkin, co-lead author of the research, calls on her colleagues to be very vigilant in protecting immunosuppressed people who are most at risk of dying from Mpox: “Everyone with Mpox should be tested for HIV. And everyone with HIV and Mpox should get a test to measure your defenses”.

Most of those who died from Mpox resided in countries where there are fewer HIV diagnoses and many infected are unaware of it, or where there is no universal access to antivirals to treat Mpox or HIV. For this reason, Mitjá highlights: “A coordinated global effort is necessary to guarantee equitable access to antivirals and vaccines in countries where the interaction of uncontrolled HIV infection and Mpox is more frequent.” “When clinicians recognize necrotizing skin lesions or lung involvement, they should use a differentiated clinical pathway and intensified approach, and health authorities should prioritize vaccination of people living with HIV.”


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