Impact of Monkeypox Virus Infection on Immune Parameters in a Woman With Human Immunodeficiency Virus Receiving Clinically Effective Antiretroviral Therapy

Abstract

We describe the immunologic and virologic impact of monkeypox (mpox) infection in a woman with human immunodeficiency virus (HIV) whose plasma HIV viremia was suppressed by clinically effective antiretroviral therapy. Extensive phenotypic analyses of B and T cells in peripheral blood and biomarkers in plasma showed significant immunologic perturbations despite the presence of mild mpox disease. Dramatic shifts were noted in the frequencies of total B cells, plasmablasts, and plasmablast immunoglobulin isotypes. Flow cytometric analyses showed a dramatic increase in the frequency of CD38+HLA-DR+ CD8+ T cells after mpox infection. Our data offer guidance for future studies involving mpox infection in affected populations.

Keywords: B cells; HIV; T cells; monkeypox; ‌Biomarkers.

Figure 1.

Clinical presentation and characteristic in a woman with human immunodeficiency virus (HIV) and mild mpox infection. A, Plasma HIV viremia since diagnosis of HIV, by duration of antiretroviral therapy (ART). B, Total CD4⁺ and CD8⁺ T-cell counts since diagnosis of HIV, by duration of ART. C, D, Appearance of mpox lesions at initial presentation on 6 September 2022 (C) and at follow-up clinic visit on 28 September 2022 (D).

Figure 2.

Dynamics of immunologic and virologic parameters in a woman with human immunodeficiency virus (HIV) and mild mpox infection. A, Changes in total B cells and plasmablasts (PBs) over the course of mpox infection. (Throughout figure, dates appear in month/date/year format.) B, Flow cytometric plots of cell surface immunoglobulin (Ig) isotype distribution among PBs at each time point. C, Frequencies of CD38⁺/HLA-DR⁺ on CD8⁺ T cells before (left), during (middle), and after (right) mpox infection. D, Frequencies of CD4⁺ and CD8⁺ T-cell subsets: naïve (T_N), central memory (T_CM), transitional memory (T_TM), effector memory (T_EM), and effector memory RA (T_EMRA). The frequencies of TIGIT, programmed cell death 1 (PD-1), CD160, CD226, 2B4 and CD38/HLA-DR on CD4⁺ and CD8⁺ T cells are shown in parallel. E, Plasma levels of granzyme B, perforin, CCL5, CCL3, interferon-gamma-inducible protein 10 (IP-10), interleukin-2 receptor α (IL-2Rα), interleukin 6 (IL-6), and programmed cell death ligand 1 (PD-L1). F, Levels of intact, 5′ defective, and 3′ defective HIV proviral DNA before, during, and after mpox infection.