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. 2024 Oct 8:ciae464.
doi: 10.1093/cid/ciae464. Online ahead of print.

Mpox in People With Human Immunodeficiency Virus: Predictors of Diagnosis, Outcomes, and Vaccine Effectiveness in a Multisite Cohort

Michalina Montaño  1 , Adrienne E Shapiro  1   2   3 , Bridget M Whitney  4 , Laura Bamford  5 , Greer Burkholder  6 , Edward R Cachay  5 , Katerina A Christopoulos  7 , Heidi M Crane  2 , Joseph A C Delaney  4 , Joseph J Eron  8 , Rob J Fredericksen  4 , Peter W Hunt  9 , Jeffrey M Jacobson  10 , Jeanne C Keruly  11 , H Nina Kim  2 , Kenneth H Mayer  12 , Richard D Moore  11 , Sonia Napravnik  8 , April Pettit  13 , Michael S Saag  6 , George A Yendewa  7 , Mari M Kitahata  2 , Rachel A Bender Ignacio  1   2
Affiliations

Mpox in People With Human Immunodeficiency Virus: Predictors of Diagnosis, Outcomes, and Vaccine Effectiveness in a Multisite Cohort

Michalina Montaño et al. Clin Infect Dis. .

Abstract

Introduction: Since its global reemergence in 2022, monkeypox (mpox) has demonstrated increased incidence and severity among people with human immunodeficiency virus (HIV [PWH]). Predictors of mpox diagnosis, vaccination, and outcomes among PWH are limited.

Methods: We included PWH with primary care visits after 1 January 2022 at 9 US sites participating in the Centers for AIDS Research Network of Integrated Clinic Systems Network. We identified mpox diagnosed between 1 June 2022 and 31 May 2023, through a combination of polymerase chain reaction result, diagnosis code, and/or tecovirimat receipt. We examined validated clinical diagnoses, laboratory results, vaccine data, and patient reported outcomes. We evaluated relative risks (RR) of mpox diagnosis, hospitalization, tecovirimat treatment, and vaccine receipt.

Findings: Among 19 777 PWH in care, 413 mpox cases (all male sex at birth) occurred (2.2 cases/100 person-years). Age <40 years, geographic region, Hispanic/Latine ethnicity, lack of antiretroviral therapy, detectable HIV viral load, and recent bacterial sexually transmitted infection predicted mpox diagnosis. PWH with CD4 200-349 cells/mm3 were most likely to be hospitalized (adjusted RR, 3.20; 95% confidence interval: 1.44-7.09) compared to CD4 ≥500, but half as likely as those with CD4 <200 to receive tecovirimat. Overall, smallpox/mpox vaccine effectiveness of ≥1 vaccine was 71% (adjusted RR, 0.29; 95% confidence interval: .14-.47) at preventing mpox, and 86% or better with CD4 ≥350 or HIV viral suppression. Non-Hispanic Black PWH were less likely to be vaccinated than other racial/ethnic identities.

Interpretation: PWH not on antiretroviral therapy or with unsuppressed HIV were more likely to be diagnosed with, and hospitalized for, mpox. Mpox/smallpox vaccine effectiveness was high, inclusive of those with low CD4 count and HIV viremia.

Keywords: HIV; Mpox; disparities; epidemic; epidemiology; vaccine effectiveness.

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Conflict of interest statement

Potential conflicts of interest. A. E. S. received funding from Merck as a clinical trial investigator for unrelated work. K. A. C. has been a medical advisory board member for Gilead Sciences and a workshop participant for Janssen outside of this work. R. B. I. is on a Scientific Advisory Board for AbbVie and received research funding from Enanta Pharmaceutics and Ascentage Pharma through her institution, unrelated to this work. The authors: No reported conflicts of interest. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest.