A severe and frightening form of MPOX has been identified in immunocompromised people living with HIV, which appears to be fatal in about 15% of cases.
Organ transplant recipients and patients with blood cancer are also at risk, although no cases have been found in these people.
Scientists are urging people at high risk of HIV to be tested for the virus, along with anyone who tests positive for MPOX, formerly known as monkey pox.
They would also like to see MPOX added to the World Health Organization’s list of very dangerous infections for people with advanced HIV, which could free up more financial and medical support for those at risk.
As of May 2022, around 85,000 cases of MPOX and 93 deaths have been reported from 110 countries worldwide. Many of these cases involve men who have sex with men, and 38-50% of people diagnosed with MPOX are also living with HIV – most of them on HIV treatment and living healthy lives.
Stimulated by reports of very severe MPOX infection in people with HIV, Prof Chloe Orkin of Queen Mary University of London and Barts Health NHS Trust and colleagues studied 382 cases of people with advanced HIV disease and MPOX, including 27 who died during MPOX infection. The current outbreak.
The virus seems to behave very differently in these people, said Orkin, whose findings were published in The Lancet. Normally the disease affects the area around the point of entry, but in this case it spread throughout the body and caused massive disfiguring ulcerated skin lesions. It also causes lung disease. That’s really bad.
Based on current data, this form of the disease appears to kill 15% of people with advanced HIV and immunosuppression although it can be as high as 27% in those with the lowest CD4 cell counts a marker of the extent of HIV weakening of the immune system.
Not everyone with HIV is at risk for this type of MPOX. Those on antiretroviral treatment for HIV and who have healthy CD4 cell counts appear to have the same symptoms and the same prognosis when infected with MPOX as those who do not have HIV. It’s a terrible disease I don’t wish it on anyone but it heals on its own, says Orkin.
However, people at risk whose CD4 count falls below 200 cells/mm3. This may include people living with undiagnosed HIV, as symptoms of the disease often do not appear until their CD4 cell count falls below critical levels.
Everyone with MPOX should be tested for HIV, and if someone has HIV and gets MPOX, their CD4 status should be measured, said Orkin. He also urged those who have delayed knowing their HIV status to get tested. Things have changed. We have a disease now circulating in humans at low levels that are potentially fatal for people with HIV and they die within a month. If you know someone who is in doubt, get tested, encourage him.
Health authorities should also prioritize people living with HIV to receive both doses of the MPOX vaccine, especially in countries with low diagnosis rates or without universal free access to antiretroviral treatment, said Prof Oriol Mitja of Germany’s Triassic University Pujol Hospital in Barcelona. First author of the study.
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