The 12th International AIDS Association HIV Science Conference (IAS 2023) was held in Brisbane, Australia from July 23 to 26, 2023. In the oral reports of the conference, experts from the World Health Organization (WHO) reported that global monitoring data for MPOX in 2022 showed that half of the patients with MPOX were HIV carriers. However, HIV is not a risk factor for increased hospitalization due to MPOX. Another study based on interviews with MPOX patients in Australia indicated that most patients had negative experiences with the disease and sequelae related to MPOX.
Half of MPOX patients worldwide carry HIV
But HIV is not a risk factor for hospitalization due to MPOX
Since May 2022, the MPOX epidemic affecting many countries has primarily affected gay, bisexual, and other men who have sex with men (GBMSM). Data from some countries show that up to 50% of MPOX cases occur among people living with HIV (PLHIV). Although HIV is not a risk factor for MPOX, it may increase the risk of complications and severe disease.
The study analyzed data from the global MPOX case surveillance system established in collaboration with the WHO, regional, and national partners (from January to December 2022). A total of 80,843 MPOX patients were included in the analysis, of which 34,973 cases (44%) had reports on HIV infection status. Of these, 48% (16,788 out of 34,973) were HIV carriers, and most (99%; 16,497 out of 16,550) were male patients.
Among the PLHIV population with information, 92% (12,071 out of 13,166) reported being men who have sex with men, 85% (14,197 out of 16,782) were aged between 18-44 years, and 63% (5,360 out of 8,529) of the cases reported acquiring MPXV through sexual contact.
Clinical symptoms in PLHIV MPOX patients included rash (79%; 10,248 out of 12,997), fever (64%), genital herpes (53%), lymphadenopathy (35%), and headache (35%).
Among PLHIV MPOX patients, 5,023 were immunocompromised, 735 required hospitalization, 20 needed intensive care, and 23 died. Compared to MPOX patients who were HIV-negative and not immunosuppressed, immunocompromised PLHIV MPOX patients had twice the risk of hospitalization (OR=2.00, P<0.001). Immunocompromised patients who were HIV-negative had a 2.5 times greater risk (OR=3.56, P<0.001). This shows that HIV alone is not a risk factor for MPOX. Due to the small sample size, no risk factors for ICU admission or death were identified.
This MPOX case report data suggests that unless there’s immunosuppression, the risk of hospitalization for PLHIV does not increase. Considering that uncontrolled HIV may lead to a disproportionate incidence of MPOX, health systems should ensure that the PLHIV population understands the importance of effective antiretroviral therapy (ART) and viral suppression in reducing the risk of hospitalization due to MPOX.
“This was the most terrifying experience of my life”
Focus on the disease experience and sequelae of MPOX patients
In May 2022, a global outbreak of MPOX occurred, with a small number of cases (n=144) detected in Australia. Few studies have focused on understanding the disease experience of MPOX patients and their medical visits. A study reported by A.KJ Smith and others aimed to document the qualitative descriptions of MPOX patients regarding their social, diagnostic, and treatment experiences.
This study, conducted from October to December 2022, interviewed 13 confirmed MPOX patients and 3 close contacts (family members or sexual partners) living in Australia. All respondents were gay or bisexual men. Most patients reported contracting MPXV during overseas vacations in July or August 2022 (n=11) and were isolated or treated in Australia (n=8).
Respondents found it very distressing to deal with the uncertainties of diagnosing, treating, and recovering from MPOX during the epidemic, and found managing severe symptoms and extended isolation periods challenging.
Physical symptoms of MPOX were mainly observed in the acute phase of the disease, including skin and mucosal lesions, fever, and pain. However, half of the respondents (n=7) reported long-term sequelae associated with MPOX, including social, psychological, and physical sequelae such as persistent changes in sexual behavior (avoiding sexual activity), ongoing fatigue, psychological distress related to pain or clinical care, severe scarring, and the need for rectal surgery.
Most of the confirmed MPOX patients (n=10) expressed dissatisfaction with clinical care, including doubts about communication with contacts, perceptions about their sexual behavior, inadequate pain management, or stigmatized care in the hospital. Respondents expressed a desire for more empathy from clinicians and more proactive pain management. This survey showed that MPOX patients may have potential, long-term physical and mental sequelae. The title of the authors’ report, “This was the most terrifying experience of my life,” expresses this unpleasant diagnostic and treatment experience, emphasizing the need for continuous attention to the recovery and care of MPOX patients.
