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. 2023 Nov 3;11(11):2701.
doi: 10.3390/microorganisms11112701.

Mpox: Clinical Outcomes and Impact of Vaccination in People with and without HIV: A Population-Wide Study

Raquel Martín-Iguacel  1   2 , Carles Pericas  3   4   5 , Andreu Bruguera  1   6   7 , Gemma Rosell  8 , Erica Martínez  5   8 , Yesika Díaz  1   6 , Lucia Alonso  1   9 , Daniel Kwakye Nomah  1   10 , Jose Luis Blanco  11 , Pere Domingo  12 , Patricia Álvarez-López  13 , Maria Saumoy Linares  14 , Consuelo Vilades Laborda  15   16 , Arantxa Mera  17 , Sonia Calzado Isbert  18 , Isik Somuncu Johansen  2 , José M Miró  11   16 , Jordi Casabona  1   7   17 , Josep M Llibre  9   19 ; PISCIS Study Group
Affiliations

Mpox: Clinical Outcomes and Impact of Vaccination in People with and without HIV: A Population-Wide Study

Raquel Martín-Iguacel et al. Microorganisms. .

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% were from Latin America. A total of 40% were PWH, with a median CD4+T-cell of 715 cells/μL; 83% had HIV-RNA < 50 copies/mL; and 1.8% CD4+T-cell < 200 cells/μL. PWH had no increased risk for complications, except those with CD4+T-cell < 200 cells/μL. 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 two years before (43%). Dose-sparing smallpox intradermal vaccination was accompanied by a sharp decrease in mpox incidence in both populations (p < 0.0001). In conclusion, unless immunosuppressed, PWH were not at increased risk of severe disease or hospitalization. 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 demonstrate the need for interventions to ensure equitable healthcare access. Dose-sparing smallpox vaccination retained effectiveness.

Keywords: HIV; immunosuppression; mpox; sexually transmitted infections.

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Conflict of interest statement

All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (accessed on 30 October 2023) and declare no support from any organization for the submitted work, no financial relationships with any organizations that might have an interest in the submitted work in the previous three years, and no other relationships or activities that could appear to have influenced the submitted work. J.M.M. received a personal 80:20 research grant from Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain, during 2017–2024 The study was investigator-driven and thus independent of any pharmaceutical company. The funding sources were not involved in study design, data collection, analyses, report writing, or the decision to submit the paper.

Figures

Figure 1
Figure 1
Flowchart.
Figure 2
Figure 2
Sexually transmitted infections (STIs) in people with mpox (with and without HIV) and in people with HIV without mpox. Abbreviations: LGV, lymphogranuloma venereum; PWH, people with HIV; PWoH, people without HIV; STIs, sexually transmitted infections. * Between 1 May 2020 and 1 May 2022.
Figure 3
Figure 3
Epidemiological curves of weekly cumulative confirmed cases of mpox in Catalonia, from 6 May 2022 to 19 December 2022, in people with HIV (PWH) and people without HIV (PWoH).
See this image and copyright information in PMC

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