Study Finds Similar Treatment Outcomes for Monkeypox Regardless of HIV Status

Patients with HIV who were treated with the antiviral tecovirimat for severe Monkeypox Virus (mpox) did not have any negative effects when compared to those without HIV.

The 2022 outbreak of mpox has burdened those with HIV and resulted in the first widespread use of tecovirimat.

For instance, research shows that about 40% of people diagnosed with mpox in the United States also have HIV. Also, people with compromised immunity — like people with untreated HIV — may experience more severe illness or even death.

Researchers of a recent study published in Annals of Internal Medicine compared the clinical presentation and treatment outcomes of people with HIV and HIV-negative persons with mpox who were treated with tecovirimat, as it was previously unclear if treatment outcomes differed between those with and without HIV.

In the retrospective cohort study, 196 people in two New York City academic medical centers were treated with tecovirimat from June to August 2022. Measured were patient demographic characteristics, clinical presentation, treatment outcomes, and safety data for tecovirimat.

Of the 154 who tested positive for mpox, 82 were HIV-negative, 72 had HIV.

The numbers of patients with and without HIV infection were similar, according to the study.

Results showed majority of patients were assigned male sex at birth, and only 1 reported female gender identity. Only 2 patients reported their partners were exclusively women.

In general, those with HIV were older and most likely Black or Hispanic. Of those with HIV infection, 14 had a viral load greater than 1000 copies/mL and 4 had a CD4 count less than 0.20 × 109 cells/L. Of the HIV-negative participants, 70% reported taking HIV PrEP at the time of their initial visit.

The study revealed a number of initial symptoms experienced by those with and without HIV. People living with HIV were more prone to skin lesions, fever, and diarrhea at the onset of illness, while those without HIV often experienced a prodrome and later developed additional symptoms.

Though previous reports indicated higher hospitalization rates among those with HIV, this study didn't show significant differences in hospitalization rates. This finding may be influenced by the low proportion of patients with low CD4 cell counts, suggesting the need for further research into disease severity among PWH with low CD4 counts.

Regarding the safety and tolerability of tecovirimat, the study confirmed its well-tolerated nature, mirroring previous findings.

As far as treatment outcomes, they appeared similar regardless of HIV status. Data revealed patients reported none or a decrease in pain by the end of treatment, and skin lesions rarely persisted post-treatment initiation. Individuals with HIV initiated tecovirimat therapy sooner, possibly indicating prompt access to care.

Though researchers found positive results in the use of tecovirimat's, there were limitations.

These limitations included the absence of a control group, potential selection bias, and the limited insight into advanced HIV cases.

As the mpox outbreak continues, researchers seek a deeper understanding of the disease and treatment in disproportionately affected populations, such as men who have intercourse with men and those with HIV.

Tecovirimat's potential as a treatment option remains promising, though further investigations are encouraged.