Raccagni Angelo Roberto, Mileto Davide, Galli Laura, Bruzzesi Elena, Canetti Diana, Rizzo Alberto, Bertoni Costanza, Clemente Tommaso, Alberton Francesca, Castagna Antonella, Nozza Silvia
Vita-Salute San Raffaele University.
Laboratory of Clinical Microbiology, Virology and Bioemergencies, Ospedale Sacco.
AIDS. 2023 Apr 1;37(5):779-783. doi: 10.1097/QAD.0000000000003479. Epub 2023 Jan 6.
Aims of this study were to assess the characteristics of Mpox among people with HIV (PWH) and describe the change of some immune-virological parameters during Mpox virus infection.
Case series of PWH diagnosed with Mpox between May and July 2022 at the Infectious Diseases Unit of San Raffaele Scientific Institute, Milan, Italy.
Real-time PCR was used to detect Mpox virus on oropharyngeal, cutaneous, genital and rectal swabs, plasma, seminal fluids, and urines. The values of the CD4 + lymphocytes and HIV-RNA were assessed both at Mpox diagnosis and after Mpox virological clearance and were compared to those prior to Mpox. The relationship between the symptoms clinical duration of Mpox and the CD4 + cell count at diagnosis was assessed with Spearman's correlation coefficient.
Overall, 28 PWH on antiretroviral therapy with Mpox were evaluated. HIV-RNA did not substantially change at Mpox infection with respect to previous virological profile ( P = 0.721). However, at time of Mpox diagnosis, we observed a detectable HIV-RNA (196 copies/ml) in one individual previously undetectable (HIV-RNA < 20 copies/ml) and an increase to 1.220 copies/ml in a previously viremic subject (HIV-RNA = 263 copies/ml). No significant differences in CD4 + cell count were found before and at time of Mpox diagnosis ( P = 0.151) and a higher CD4 + cell count at Mpox diagnosis was marginally related to a lower duration of Mpox symptoms ( r = -0.341, P = 0.068).
Among PWH, we advise monitoring HIV viral load at Mpox diagnosis and during follow-up, as well as providing counseling on the results, due to the important individual and community implications.
本研究旨在评估人类免疫缺陷病毒（HIV）感染者（PWH）中猴痘的特征，并描述猴痘病毒感染期间一些免疫病毒学参数的变化。
对2022年5月至7月在意大利米兰圣拉斐尔科学研究所传染病科诊断为猴痘的PWH进行病例系列研究。
采用实时聚合酶链反应（PCR）检测口咽、皮肤、生殖器和直肠拭子、血浆、精液和尿液中的猴痘病毒。在猴痘诊断时和猴痘病毒学清除后评估CD4 +淋巴细胞和HIV-RNA的值，并与猴痘之前的值进行比较。用Spearman相关系数评估猴痘症状临床持续时间与诊断时CD4 +细胞计数之间的关系。
总体而言，对28例接受抗逆转录病毒治疗的猴痘PWH进行了评估。与之前的病毒学特征相比，猴痘感染时HIV-RNA没有实质性变化（P = 0.721）。然而，在猴痘诊断时，我们观察到一名之前检测不到HIV-RNA（HIV-RNA < 20拷贝/毫升）的个体中可检测到HIV-RNA（196拷贝/毫升），以及一名之前病毒血症患者（HIV-RNA = 263拷贝/毫升）的HIV-RNA增加到1220拷贝/毫升。猴痘诊断前和诊断时CD4 +细胞计数没有显著差异（P = 0.151），猴痘诊断时较高的CD4 +细胞计数与猴痘症状持续时间较短略有相关（r = -0.341，P = 0.068）。
在PWH中，由于重要的个人和社区影响，我们建议在猴痘诊断时和随访期间监测HIV病毒载量，并就结果提供咨询。
