Monkeypox (mpox): Clinical Outcomes and Impact of Vaccination in People with and without HIV: A Population-Wide Study

Martín-Iguacel, R.; Pericas, C.; Bruguera, A.; Rosell, G.; Martínez, E.; Díaz, Y.; Alonso, L.; Nomah, D.K.; Blanco, J.L.; Domingo, P.; Álvarez-López, P.; Linares, M.S.; Vilades Laborda, C.; Mera, A.; Calzado Isbert, S.; Johansen, I.S.; Miró, J.M.; Casabona, J.; Llibre, J.M. Mpox: Clinical Outcomes and Impact of Vaccination in People with and without HIV: A Population-Wide Study. Microorganisms 2023, 11, 2701. Martín-Iguacel, R.; Pericas, C.; Bruguera, A.; Rosell, G.; Martínez, E.; Díaz, Y.; Alonso, L.; Nomah, D.K.; Blanco, J.L.; Domingo, P.; Álvarez-López, P.; Linares, M.S.; Vilades Laborda, C.; Mera, A.; Calzado Isbert, S.; Johansen, I.S.; Miró, J.M.; Casabona, J.; Llibre, J.M. Mpox: Clinical Outcomes and Impact of Vaccination in People with and without HIV: A Population-Wide Study. Microorganisms 2023, 11, 2701.

Abstract

We investigated differences in mpox clinical outcomes in people with HIV (PWH) and without HIV (PWoH) and the impact of vaccination in Catalonia, Spain. We used surveillance data and the PISCIS HIV Cohort. We included all confirmed mpox cases (May-December 2022). Of 2122 mpox cases, the majority had mild disease, 56% were Spanish, and 24% from Latin-America. Forty percent were PWH, with median CD4+T-cell 715 cells/µL, 83% had HIV-RNA<50 copies/ml and 1.8% CD4+T-cell<200 cells/L. PWH had no increased risk for complications, except in cases of immunosuppression. PWH with CD4+T-cell<200 cells/µL were more likely to be from Latin-America, had more generalized exanthema, and required hospitalization more frequently (p=0.001). Diagnosis of other sexually transmitted infections (STIs) was common, both at mpox diagnosis (17%) and 2 years before (43%). Dose-sparing smallpox vaccination was accompanied by a sharp decrease in mpox incidence in both populations (p<0.0001). In conclusion, PWH were not at increased risk of severe disease or hospitalization unless immunosuppressed. Mpox is a marker of high-risk sexual behavior and was associated with high HIV and STI rates, supporting the need for screening in all mpox cases. Ethnicity disparities underscore the need for interventions to ensure equitable healthcare access. Dose-sparing smallpox vaccination retained effectiveness.

Keywords

mpox; monkeypox; sexually transmitted infections; HIV; immunosuppression

Subject

Medicine and Pharmacology, Epidemiology and Infectious Diseases

Copyright: This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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