Editor’s note:
In 2022, about 70 countries/regions around the world reported cases of MPOX. These countries/regions usually have no prior history of MPXV infections, and previous sustained human-to-human transmissions of MPXV were mainly observed in Africa. At the recent 12th International AIDS Society HIV Science Conference (IAS 2023), Dr. Ana Hoxha from the World Health Organization (WHO) presented a special report titled “HIV among MPOX cases: clinical characteristics and outcomes in the WHO global surveillance 2022”. The report, based on over 82,000 patients in the WHO’s global MPOX surveillance system, detailed the clinical characteristics and outcomes of HIV-infected individuals among the 2022 MPOX cases. Dr. Hoxha was interviewed on-site by Infectious Disease Frontier.
Infectious Disease Frontier: According to the WHO global surveillance data, how prevalent is MPOX in PLWHs (People Living With HIV)? What are the similarities and differences between HIV and MPXV transmissions?
Dr. Hoxha: I want to highlight that the surveillance data on MPOX only contains cases of MPOX. We do not have complete data on all the people living with HIV. Hence, we cannot say what the prevalence of MPOX is among people living with HIV. What we do know is the prevalence of HIV among those who contracted MPXV. In our data, around 52% of these cases are people living with HIV. In terms of transmission similarities and differences, it was originally believed that MPOX primarily spread through direct touch, mainly with the lesions and fluids from these lesions. A recent finding, starting from the outbreak in Nigeria in 2017-2018, is that sexual contact, which involves close physical contact, increases the risk of contracting MPXV. We know that HIV mainly spreads through body fluids like seminal and vaginal fluids, so it’s not spread through mere touch or contact with an HIV positive individual, as they won’t manifest visible lesions and thus there’s no risk of transmission. For MPXV, transmission occurs through contact with lesions and the fluids or crusts from these lesions.
Infectious Disease Frontier: Are the clinical symptoms and prognosis for patients coinfected with MPXV and HIV more severe?
Dr. Hoxha: People living with HIV, who have managed HIV, will show symptoms like lesions and pain if they contract MPXV. However, their prognosis isn’t different from those not living with HIV. Those at risk of severe outcomes, including hospitalization and death from MPOX, are individuals who have uncontrolled HIV — they might be unaware of their HIV status, may not be on treatment, or their treatment isn’t effective, leaving them immunocompromised.
Infectious Disease Frontier: Is there any prognostic marker for patients coinfected with MPXV and HIV, such as CD4 count or others?
Dr. Hoxha: Based on our data, we can’t determine that since we don’t have detailed clinical data on CD4 counts. However, other studies with more detailed clinical data on cases over time indicate that low CD4 counts below 200 are linked to an increased risk of severe MPOX.
Infectious Disease Frontier: Given the high prevalence of co-infection with MPXV and HIV, should PLWHs prioritize getting vaccinated against MPXV? Does vaccination interfere with ART?
Dr. Hoxha: Currently, we don’t think there’s any interaction between MPXV vaccines and ART, so we can’t provide a definitive answer. At the moment, the MPXV vaccine is recommended for high-risk groups, which includes people living with HIV, especially if they are sexually active, have multiple partners, or partners of unknown status.
