Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.
The Ponce Center, Grady Health System, Atlanta, Georgia, USA.
J Infect Dis. 2024 Mar 26;229(Supplement_2):S234-S242. doi: 10.1093/infdis/jiad505.
In the Southeastern United States, the 2022 mpox outbreak disproportionately impacted people who are black and people with HIV (PWH).
We analyzed a cohort of 395 individuals diagnosed with mpox across 3 health care systems in Atlanta, Georgia between 1 June 2022 and 7 October 2022. We present demographic and clinical characteristics and use multivariable logistic regression analyses to evaluate the association between HIV status and severe mpox (per the US Centers for Disease Control and Prevention definition) and, among PWH, the associations between CD4+ T-cell count and HIV load with severe mpox.
Of 395 people diagnosed with mpox, 384 (97.2%) were cisgender men, 335 (84.8%) identified as black, and 324 (82.0%) were PWH. Of 257 PWH with a known HIV load, 90 (35.0%) had > 200 copies/mL. Severe mpox occurred in 77 (19.5%) individuals and there was 1 (0.3%) death. Tecovirimat was prescribed to 112 (28.4%) people, including 56 (72.7%) people with severe mpox. In the multivariable analysis of the total population, PWH had 2.52 times higher odds of severe mpox (95% confidence interval [CI], 1.01-6.27) compared with people without HIV. In the multivariable analysis of PWH, individuals with HIV load > 200 copies/mL had 2.10 (95% CI, 1.00-4.39) times higher odds of severe mpox than PWH who were virologically suppressed. Lower CD4+ T-cell count showed a significant univariate association with severe mpox but was not found to be significantly associated with severe mpox in multivariable analysis.
PWH with nonsuppressed HIV loads had more mpox complications, hospitalizations, and protracted disease courses than people without HIV or PWH with suppressed viral loads. PWH with nonsuppressed HIV loads who are diagnosed with mpox warrant particularly aggressive monitoring and treatment.
在东南部，2022 年猴痘疫情 disproportionately 影响了黑人及 HIV 感染者（PWH）。
我们分析了佐治亚州亚特兰大的 3 个医疗系统中，在 2022 年 6 月 1 日至 10 月 7 日期间确诊的 395 例猴痘患者的队列。我们展示了人口统计学和临床特征，并使用多变量逻辑回归分析来评估 HIV 状况与严重猴痘（根据美国疾病控制与预防中心的定义）之间的关联，以及在 PWH 中，CD4+ T 细胞计数和 HIV 载量与严重猴痘之间的关联。
在 395 例确诊的猴痘患者中，384 例（97.2%）为 cisgender 男性，335 例（84.8%）为黑人，324 例（82.0%）为 PWH。在 257 例已知 HIV 载量的 PWH 中，90 例（35.0%）> 200 拷贝/mL。77 例（19.5%）患者发生严重猴痘，1 例（0.3%）死亡。112 例（28.4%）患者开了特考韦瑞，其中 56 例（72.7%）为严重猴痘患者。在总人群的多变量分析中，与未感染 HIV 的人相比，PWH 发生严重猴痘的几率高出 2.52 倍（95%置信区间 [CI]，1.01-6.27）。在 PWH 的多变量分析中，HIV 载量> 200 拷贝/mL 的患者发生严重猴痘的几率是 HIV 得到抑制的 PWH 的 2.10 倍（95%CI，1.00-4.39）。较低的 CD4+ T 细胞计数与严重猴痘有显著的单变量关联，但在多变量分析中未发现与严重猴痘有显著关联。
与未感染 HIV 或 HIV 得到抑制的 PWH 相比，HIV 载量未得到抑制的 PWH 发生猴痘并发症、住院和病程延长的情况更多。诊断患有猴痘的 HIV 载量未得到抑制的 PWH 需要特别积极的监测和治疗。
