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

Michalina Montaño; Adrienne E Shapiro; Bridget M Whitney; Laura Bamford; Greer Burkholder; Edward R Cachay; Katerina A Christopoulos; Heidi M Crane; Joseph A C Delaney; Joseph J Eron; Rob J Fredericksen; Peter W Hunt; Jeffrey M Jacobson; Jeanne C Keruly; H Nina Kim; Kenneth H Mayer; Richard D Moore; Sonia Napravnik; April Pettit; Michael S Saag; George A Yendewa; Mari M Kitahata; Rachel A Bender Ignacio

doi:10.1093/cid/ciae464

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

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

Authors

Michalina Montaño¹, Adrienne E Shapiro^{1

2

3}, Bridget M Whitney⁴, Laura Bamford⁵, Greer Burkholder⁶, Edward R Cachay⁵, Katerina A Christopoulos⁷, Heidi M Crane², Joseph A C Delaney⁴, Joseph J Eron⁸, Rob J Fredericksen⁴, Peter W Hunt⁹, Jeffrey M Jacobson¹⁰, Jeanne C Keruly¹¹, H Nina Kim², Kenneth H Mayer¹², Richard D Moore¹¹, Sonia Napravnik⁸, April Pettit¹³, Michael S Saag⁶, George A Yendewa⁷, Mari M Kitahata², Rachel A Bender Ignacio^{1

2}

Affiliations

¹ Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA.
² Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA.
³ Department of Global Health, University of Washington, Seattle, Washington, USA.
⁴ Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA.
⁵ Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, California, USA.
⁶ Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, USA.
⁷ Division of HIV, ID, and Global Medicine, University of California, San Francisco, California, USA.
⁸ Division of Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina, USA.
⁹ Division of Experimental Medicine, University of California San Francisco, San Francisco, California, USA.
¹⁰ Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
¹¹ Departments of Medicine and Epidemiology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
¹² Fenway Health and Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, The Fenway Institute, Boston, Massachusetts, USA.
¹³ Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, USA.

PMID: 39377755
DOI: 10.1093/cid/ciae464

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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Abstract

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