Researchers have identified a “severe” form of the mpox virus infection – formerly known as monkeypox – that causes high rates of mortality in people living with advanced HIV disease.
Clinicians, including those from the Queen Mary University of London, are calling for this form of the disease to be added to the World Health Organization and Center for Disease Control list of severe infections that are considered particularly dangerous to people with HIV with compromised immunity.
While previous studies of the virus, that emerged last year, has suggested that the mpox infection may be more severe in people with advanced HIV, there has been no large global study to examine this further until now.
In the new study, published on Tuesday in the journal The Lancet, scientists assessed 382 people with advanced HIV disease and mpox, including 27 of the 60 people reported to have died of mpox during the multi-country outbreak.
“This data highlights that mpox remains a significant threat to the lives of people with advanced HIV, a group who may not be getting the healthcare they need, including mpox vaccination,” Matthew Hodson, executive director of the charity NAM aidsmap said in a statement.
From the analysis, they found a very severe form of the mpox infection that is characterised by widespread, large, decomposing skin lesions which are in some cases unusually long, and also show signs of high rates of severe infections.
This form of the disease, researchers say, carries a 15 per cent mortality in people with advanced HIV disease with all the reported 27 deaths in the study occurring within this group.
The findings suggest the disease is behaving “differently and very concerningly” in people with advanced HIV disease and compromised immunity.
“We describe a severe form of mpox affecting mostly young men who have sex with men and which results in death in 15 per cent of people with advanced HIV,” Oriol Mitjà, first author of the study from the University Hospital Germans Trias i Pujol, said.
Researchers found that the mpox complications affecting all organ systems become common with increasing suppression of the immune system by HIV.
“The hallmark feature of this severe disseminated form of MPOX was large coalescing and necrotising lesions which occurred in 93 per cent of those who died,” Chloe Orkin, another author of the study, explained.
“Sepsis occurred in 89 per cent of those who died and respiratory symptoms in 85 per cent,” Dr Orkin explained.
While normally the mpox disease affects the area around the virus’s site of entry, in this severe form, she says it spreads all over the body and causes massive skin lesions.
“It is also causing lung disease. It is horrific,” Dr Orkin told The Guardian.
Researchers are calling for this version of the mpox disease to be added to globally recognised AIDS-defining conditions, which are serious and life-threatening for people with advanced HIV-related disease.
This categorisation they say can help clinicians worldwide to guide management of people most at risk of dying from these infections.
“When clinicians recognize necrotizing skin lesions and/or lung involvement, they should use a differentiated clinical pathway and an intensified approach,” Dr Mitja said.
A person may have advanced HIV-related disease when their CD4 cell count– a type of cell in the immune system – is less than 200 cells/mm3.
In comparison, a healthy person living with or without HIV has CD4 counts of over 500 cells/mm3.
Scientists caution that a concerted global effort is needed to ensure equitable access to antivirals and vaccines in countries where the interaction of uncontrolled HIV infection and mpox is more prevalent.
“We therefore call for mpox to be added to this list of ‘AIDS-defining conditions’ as it is an opportunistic infection. No new or emerging infections have been added to the CDC I-classification since 1993,” study lead author Chloe Orkin said in a statement.
Researchers say routine HIV testing for people diagnosed with mpox could potentially reduce mpox-related deaths and advanced HIV disease.