Mpox in people with advanced HIV infection: a global case series

Mitjà, Oriol; Alemany, Andrea; Marks, Michael; Lezama Mora, Jezer I; Rodríguez-Aldama, Juan Carlos; Silva, Mayara Secco Torres; Corral Herrera, Ever Arturo; Crabtree-Ramirez, Brenda; Blanco, José Luis; Girometti, Nicolo; Mazzotta, Valentina; Hazra, Aniruddha; Silva, Macarena; Montenegro-Idrogo, Juan José; Gebo, Kelly; Ghosn, Jade; Peña Vázquez, María Fernanda; Prado, Eduardo Matos; Unigwe, Uche; Villar-García, Judit; Wald-Dickler, Noah; Zucker, Jason; Paredes, Roger; Calmy, Alexandra; Waters, Laura; Galvan-Casas, Cristina; Walmsley, Sharon; Orkin, Chloe M.

Mpox in people with advanced HIV infection: a global case series

Detalhes bibliográficos
Autor(a) principal:	Mitjà, Oriol
Data de Publicação:	2023
Outros Autores:	Alemany, Andrea, Marks, Michael, Lezama Mora, Jezer I, Rodríguez-Aldama, Juan Carlos, Silva, Mayara Secco Torres, Corral Herrera, Ever Arturo, Crabtree-Ramirez, Brenda, Blanco, José Luis, Girometti, Nicolo, Mazzotta, Valentina, Hazra, Aniruddha, Silva, Macarena, Montenegro-Idrogo, Juan José, Gebo, Kelly, Ghosn, Jade, Peña Vázquez, María Fernanda, Prado, Eduardo Matos, Unigwe, Uche, Villar-García, Judit, Wald-Dickler, Noah, Zucker, Jason, Paredes, Roger, Calmy, Alexandra, Waters, Laura, Galvan-Casas, Cristina, Walmsley, Sharon, Orkin, Chloe M.
Tipo de documento:	Artigo
Idioma:	eng
Título da fonte:	Repositório Institucional da FIOCRUZ (ARCA)
Texto Completo:	https://www.arca.fiocruz.br/handle/icict/57500
Resumo:	2023

Metadados do item

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network_acronym_str	CRUZ
network_name_str	Repositório Institucional da FIOCRUZ (ARCA)
repository_id_str	2135
spelling	Mitjà, OriolAlemany, AndreaMarks, MichaelLezama Mora, Jezer IRodríguez-Aldama, Juan CarlosSilva, Mayara Secco TorresCorral Herrera, Ever ArturoCrabtree-Ramirez, BrendaBlanco, José LuisGirometti, NicoloMazzotta, ValentinaHazra, AniruddhaSilva, MacarenaMontenegro-Idrogo, Juan JoséGebo, KellyGhosn, JadePeña Vázquez, María FernandaPrado, Eduardo MatosUnigwe, UcheVillar-García, JuditWald-Dickler, NoahZucker, JasonParedes, RogerCalmy, AlexandraWaters, LauraGalvan-Casas, CristinaWalmsley, SharonOrkin, Chloe M.2023-03-22T14:41:31Z2023-03-22T14:41:31Z2023MITJÀ, Oriol et al. Mpox in people with advanced HIV infection: a global case series. The Lancet, p. 1-11, 2023.0140-6736https://www.arca.fiocruz.br/handle/icict/5750010.1016/S0140-6736(23)00273-8engThe LancetVaríola dos macacosHIVInfecção por HIVMpoxHIVHIV infectionMpox in people with advanced HIV infection: a global case seriesinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/article2023University Hospital Germans Trias i Pujol. Fight Infectious Diseases Foundation. Skin Neglected Tropical Diseases and Sexually Transmitted Infections section. Badalona, Spain.University Hospital Germans Trias i Pujol. Fight Infectious Diseases Foundation. Skin Neglected Tropical Diseases and Sexually Transmitted Infections section. Badalona, Spain.University Hospital Germans Trias i Pujol, Badalona, Spain / London School of Hygiene & Tropical Medicine Clinical Research Department. London, UK / University College London Hospitals. Hospital for Tropical Diseases, and Division of Infection and Immunity. London, UK.Clínica Especializada Condesa Cuauhtémoc. Mexico City, México.Clínica Especializada Condesa Iztapalapa. Mexico City, México.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil.Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán. Departamento de Infectología, México City, México.Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán. Departamento de Infectología, México City, México.Barcelona University. Hospital Clínic de Barcelona. Infectious Diseases Department. Barcelona, Spain / Instituto de Salud Carlos III. Centro de Investigación Biomédica en Red de Enfermedades Infecciosas. Madrid, Spain / Institut d’Investigacions Mèdiques August Pi i Sunyer. Barcelona, Spain.Chelsea and Westminster Hospital NHS Foundation Trust. Department of HIV and Genitourinary Medicine. London, UK.National Institute for Infectious Disease Lazzaro Spallanzani. Rome, Italy.University of Chicago Medicine. Section of Infectious Diseases and Global Health. Chicago, IL, USA.Hospital San Borja Arriarán. Infectious Diseases Department. Santiago, Chile,Hospital Nacional Dos de Mayo. Infectious Diseases Department. Lima, Perú / Centro de Investigaciones Tecnológicas Biomédicas y Medioambientales. Lima, Perú.Johns Hopkins University School of Medicine. Division of Infectious Diseases, Baltimore, MD, USA.Assistance Publique - Hôpitaux de Paris Nord. Bichat University Hospital, Paris, France / Université Paris Cité. Centre of Research in Epidemiology and Statistics. INSERM UMR 1137 IAME. Paris, FranceHospital Enrique Garcés del Sur. Infectious Diseases Department. Quito, Ecuador.Hospital Nacional Arzobispo Loayza. Infectious Diseases Department. Lima, Perú.University of Nigeria Teaching Hospital. Infectious Disease Unit Department of Medicine. Enugu, Nigeria.Hospital del Mar. Infectious Disease Unit. Barcelona, Spain /Hospital del Mar Medical Research Institute. Infectious Diseases and Antibiotic Therapy Research Group. Barcelona, Spain.Los Angeles County and University of Southern California Medical Center. Los Angeles, CA, USA / University of Southern California. Keck School of Medicine. Los Angeles, CA, USA.Columbia University Irving Medical Center. Division of Infectious Diseases. New York, NY, USA.University Hospital Germans Trias i Pujol. Fight Infectious Diseases Foundation. Infectious Disease Department. Badalona, Spain.Geneva University Hospitals. Division of Infectious Diseases. HIV/AIDS Unit. Geneva, Switzerland.Central and North West London NHS Trust. London, UK.University Hospital Germans Trias i Pujol. Fight Infectious Diseases Foundation. Skin Neglected Tropical Diseases and Sexually Transmitted Infections section. Badalona, Spain / Hospital Universitario de Móstoles. Dermatology Department. Madrid, Spain.University Health Network. Toronto, Canada / University of Toronto. Toronto, Canada.Queen Mary University of London. London, UK / Barts Health NHS Trust. Department of Infection and Immunity. London, UK.Background: People living with HIV have accounted for 38–50% of those affected in the 2022 multicountry mpox outbreak. Most reported cases were in people who had high CD4 cell counts and similar outcomes to those without HIV. Emerging data suggest worse clinical outcomes and higher mortality in people with more advanced HIV. We describe the clinical characteristics and outcomes of mpox in a cohort of people with HIV and low CD4 cell counts (CD4 <350 cells per mm³). Methods: A network of clinicians from 19 countries provided data of confirmed mpox cases between May 11, 2022, and Jan 18, 2023, in people with HIV infection. Contributing centres completed deidentified structured case report sheets to include variables of interest relevant to people living with HIV and to capture more severe outcomes. We restricted this series to include only adults older than 18 years living with HIV and with a CD4 cell count of less than 350 cells per mm³ or, in settings where a CD4 count was not always routinely available, an HIV infection clinically classified as US Centers for Disease Control and Prevention stage C. We describe their clinical presentation, complications, and causes of death. Analyses were descriptive. Findings: We included data of 382 cases: 367 cisgender men, four cisgender women, and ten transgender women. The median age of individuals included was 35 (IQR 30–43) years. At mpox diagnosis, 349 (91%) individuals were known to be living with HIV; 228 (65%) of 349 adherent to antiretroviral therapy (ART); 32 (8%) of 382 had a concurrent opportunistic illness. The median CD4 cell count was 211 (IQR 117–291) cells per mm³, with 85 (22%) individuals with CD4 cell counts of less than 100 cells per mm³ and 94 (25%) with 100–200 cells per mm³. Overall, 193 (51%) of 382 had undetectable viral load. Severe complications were more common in people with a CD4 cell count of less than 100 cells per mm³ than in those with more than 300 cells per mm³, including necrotising skin lesions (54% vs 7%), lung involvement (29% vs 0%) occasionally with nodules, and secondary infections and sepsis (44% vs 9%). Overall, 107 (28%) of 382 were hospitalised, of whom 27 (25%) died. All deaths occurred in people with CD4 counts of less than 200 cells per mm³. Among people with CD4 counts of less than 200 cells per mm³, more deaths occurred in those with high HIV viral load. An immune reconstitution inflammatory syndrome to mpox was suspected in 21 (25%) of 85 people initiated or re-initiated on ART, of whom 12 (57%) of 21 died. 62 (16%) of 382 received tecovirimat and seven (2%) received cidofovir or brincidofovir. Three individuals had laboratory confirmation of tecovirimat resistance. Interpretation: A severe necrotising form of mpox in the context of advanced immunosuppression appears to behave like an AIDS-defining condition, with a high prevalence of fulminant dermatological and systemic manifestations and death. Funding: None.info:eu-repo/semantics/openAccessreponame:Repositório Institucional da FIOCRUZ (ARCA)instname:Fundação Oswaldo Cruz (FIOCRUZ)instacron:FIOCRUZLICENSElicense.txtlicense.txttext/plain; charset=utf-82991https://www.arca.fiocruz.br/bitstream/icict/57500/1/license.txt5a560609d32a3863062d77ff32785d58MD51ORIGINALve_Mitjà_Oriol_etal_INI_2023.pdfve_Mitjà_Oriol_etal_INI_2023.pdfapplication/pdf3304269https://www.arca.fiocruz.br/bitstream/icict/57500/2/ve_Mitj%c3%a0_Oriol_etal_INI_2023.pdfbbfb1869bb1225f2e922fd6ba99fa1caMD52icict/575002023-03-24 19:44:18.664oai:www.arca.fiocruz.br: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ório InstitucionalPUBhttps://www.arca.fiocruz.br/oai/requestrepositorio.arca@fiocruz.bropendoar:21352023-03-24T22:44:18Repositório Institucional da FIOCRUZ (ARCA) - Fundação Oswaldo Cruz (FIOCRUZ)false
dc.title.en_US.fl_str_mv	Mpox in people with advanced HIV infection: a global case series
title	Mpox in people with advanced HIV infection: a global case series
spellingShingle	Mpox in people with advanced HIV infection: a global case series Mitjà, Oriol Varíola dos macacos HIV Infecção por HIV Mpox HIV HIV infection
title_short	Mpox in people with advanced HIV infection: a global case series
title_full	Mpox in people with advanced HIV infection: a global case series
title_fullStr	Mpox in people with advanced HIV infection: a global case series
title_full_unstemmed	Mpox in people with advanced HIV infection: a global case series
title_sort	Mpox in people with advanced HIV infection: a global case series
author	Mitjà, Oriol
author_facet	Mitjà, Oriol Alemany, Andrea Marks, Michael Lezama Mora, Jezer I Rodríguez-Aldama, Juan Carlos Silva, Mayara Secco Torres Corral Herrera, Ever Arturo Crabtree-Ramirez, Brenda Blanco, José Luis Girometti, Nicolo Mazzotta, Valentina Hazra, Aniruddha Silva, Macarena Montenegro-Idrogo, Juan José Gebo, Kelly Ghosn, Jade Peña Vázquez, María Fernanda Prado, Eduardo Matos Unigwe, Uche Villar-García, Judit Wald-Dickler, Noah Zucker, Jason Paredes, Roger Calmy, Alexandra Waters, Laura Galvan-Casas, Cristina Walmsley, Sharon Orkin, Chloe M.
author_role	author
author2	Alemany, Andrea Marks, Michael Lezama Mora, Jezer I Rodríguez-Aldama, Juan Carlos Silva, Mayara Secco Torres Corral Herrera, Ever Arturo Crabtree-Ramirez, Brenda Blanco, José Luis Girometti, Nicolo Mazzotta, Valentina Hazra, Aniruddha Silva, Macarena Montenegro-Idrogo, Juan José Gebo, Kelly Ghosn, Jade Peña Vázquez, María Fernanda Prado, Eduardo Matos Unigwe, Uche Villar-García, Judit Wald-Dickler, Noah Zucker, Jason Paredes, Roger Calmy, Alexandra Waters, Laura Galvan-Casas, Cristina Walmsley, Sharon Orkin, Chloe M.
author2_role	author author author author author author author author author author author author author author author author author author author author author author author author author author author
dc.contributor.author.fl_str_mv	Mitjà, Oriol Alemany, Andrea Marks, Michael Lezama Mora, Jezer I Rodríguez-Aldama, Juan Carlos Silva, Mayara Secco Torres Corral Herrera, Ever Arturo Crabtree-Ramirez, Brenda Blanco, José Luis Girometti, Nicolo Mazzotta, Valentina Hazra, Aniruddha Silva, Macarena Montenegro-Idrogo, Juan José Gebo, Kelly Ghosn, Jade Peña Vázquez, María Fernanda Prado, Eduardo Matos Unigwe, Uche Villar-García, Judit Wald-Dickler, Noah Zucker, Jason Paredes, Roger Calmy, Alexandra Waters, Laura Galvan-Casas, Cristina Walmsley, Sharon Orkin, Chloe M.
dc.subject.other.en_US.fl_str_mv	Varíola dos macacos HIV Infecção por HIV
topic	Varíola dos macacos HIV Infecção por HIV Mpox HIV HIV infection
dc.subject.en.en_US.fl_str_mv	Mpox HIV HIV infection
description	2023
publishDate	2023
dc.date.accessioned.fl_str_mv	2023-03-22T14:41:31Z
dc.date.available.fl_str_mv	2023-03-22T14:41:31Z
dc.date.issued.fl_str_mv	2023
dc.type.status.fl_str_mv	info:eu-repo/semantics/publishedVersion
dc.type.driver.fl_str_mv	info:eu-repo/semantics/article
format	article
status_str	publishedVersion
dc.identifier.citation.fl_str_mv	MITJÀ, Oriol et al. Mpox in people with advanced HIV infection: a global case series. The Lancet, p. 1-11, 2023.
dc.identifier.uri.fl_str_mv	https://www.arca.fiocruz.br/handle/icict/57500
dc.identifier.issn.en_US.fl_str_mv	0140-6736
dc.identifier.doi.none.fl_str_mv	10.1016/S0140-6736(23)00273-8
identifier_str_mv	MITJÀ, Oriol et al. Mpox in people with advanced HIV infection: a global case series. The Lancet, p. 1-11, 2023. 0140-6736 10.1016/S0140-6736(23)00273-8
url	https://www.arca.fiocruz.br/handle/icict/57500
dc.language.iso.fl_str_mv	eng
language	eng
dc.rights.driver.fl_str_mv	info:eu-repo/semantics/openAccess
eu_rights_str_mv	openAccess
dc.publisher.none.fl_str_mv	The Lancet
publisher.none.fl_str_mv	The Lancet
dc.source.none.fl_str_mv	reponame:Repositório Institucional da FIOCRUZ (ARCA) instname:Fundação Oswaldo Cruz (FIOCRUZ) instacron:FIOCRUZ
instname_str	Fundação Oswaldo Cruz (FIOCRUZ)
instacron_str	FIOCRUZ
institution	FIOCRUZ
reponame_str	Repositório Institucional da FIOCRUZ (ARCA)
collection	Repositório Institucional da FIOCRUZ (ARCA)
bitstream.url.fl_str_mv	https://www.arca.fiocruz.br/bitstream/icict/57500/1/license.txt https://www.arca.fiocruz.br/bitstream/icict/57500/2/ve_Mitj%c3%a0_Oriol_etal_INI_2023.pdf
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bitstream.checksumAlgorithm.fl_str_mv	MD5 MD5
repository.name.fl_str_mv	Repositório Institucional da FIOCRUZ (ARCA) - Fundação Oswaldo Cruz (FIOCRUZ)
repository.mail.fl_str_mv	repositorio.arca@fiocruz.br
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Mpox in people with advanced HIV infection: a global case series

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