15 percent mortality rate, severe lesions in patients with mpox alongside advanced HIV: study
During Canada’s unprecedented MPOX outbreak last summer, physician Dr. Antoine Cloutier-Blais of Montreal reported a worrying trend: patients co-infected with advanced HIV reported full-body lesions and systemic MPOX symptoms.
“It was difficult at the time to confirm that suspicion with the data we had,” he said.
Now, new research in the medical journal Lancet substantiates Cloutier-Blais’ early concerns.
The paper, a case study of MPOX in people with advanced HIV infection, describes an aggressive and severe form of the disease formerly known as monkeypox – sometimes with skin cell death within lesions, nodules in the lungs, sepsis and a high rate of death .
This form of MPOX appears to be a “very severe skin and mucosal infection with high rates of sepsis and very severe pulmonary complications,” said study author Dr. Chloe Orkin, Professor of HIV/AIDS Medicine at Queen Mary University of London, in an email to CBC News.
Researchers studied a cohort of nearly 400 patients from different countries, including Canada, who became infected with MPOX while living with HIV and low CD4 cell counts. (CD4 cells are a type of white blood cell that help fight off infection by prompting the immune system to destroy viruses and other pathogens.)
Mortality was about 15 percent in people with advanced HIV-related disease, the researchers wrote, while the mortality rate doubled to about 30 percent in people with the most severe immunosuppression, Orkin noted.
The startling results are significant in large part because of the high rates of Mpox in people living with HIV/AIDS, which are estimated to account for 38 to 50 percent of people diagnosed with Mpox.
“I think it’s an important reminder that even with low case numbers, we can’t get too complacent because when the virus hits a person who’s prone to manifestations as severe as people with advanced HIV, then it really can be devastating,” said Dr. Darrell Tan, a clinical scientist at St. Michael’s Hospital in Toronto, whose team contributed data to the Lancet paper.
Calls for more access to MPOX vaccines
The takeaway from their findings, Orkin said, is that healthcare workers need to be educated about the high mortality rate associated with mpox and HIV-related immunosuppression.
“Every person with mpox should have an HIV test and every person with HIV and mpox should be tested for immunosuppression,” Orkin continued, noting that people with advanced HIV infection should also be carefully monitored given the significantly higher risk of death.
“Access to MPOX vaccines and antiviral treatments is the best way to reduce the severity of the disease, and public health officials should ensure that vaccination and antiviral medications are prioritized for people living with HIV, particularly those with immunosuppression,” she added .
In Montreal, Cloutier-Blais – who was not involved in the Lancet study – agreed vaccines must be an ongoing priority, noting reassuringly that he now “rarely” encounters patients who don’t receive at least one dose of the two have. Shot MPOX vaccine.
“I haven’t seen a single one [two-dose] Failure and infrequent and mild presentations in dosed patients,” he added.
However, uptake and access remain a challenge on a global scale.
“We certainly have patients in our care who have low CD4 levels and could be susceptible to these types of diseases and their uptake [second doses] in Ontario were disappointingly low,” Tan said in Toronto.
“There is also a particular risk in many parts of the world where there is no access to protective MPOX vaccines and where the HIV burden is high.”
Data shows demand for second doses has fallen in many major cities, while many countries – including those in Africa and emerging outbreak hotspot Mexico – have no vaccines available at all.
“It is imperative that vaccines and antivirals become globally accessible and this is where greater global collaboration is needed,” Orkin said.