Institute for Global Health, University College London.
Mortimer Market Centre, Central and North West London NHS Foundation Trust, London, UK.
Curr Opin Infect Dis. 2024 Feb 1;37(1):1-7. doi: 10.1097/QCO.0000000000000994. Epub 2023 Dec 7.
The 2022 global outbreak of mpox disproportionally affected people with HIV (PWH). We review the data on the presentation, treatment, and prevention of mpox in PWH.
Most PWH with mpox had a mild and self-limiting illness, no different to people without HIV. A higher rate of rectal symptoms has been reported among PWH and those with advanced HIV disease were at higher risk of severe disease, hospitalization, and death. Treatment with antivirals was widely used in hospitalized patients without any randomized control trial data to support its use and without any data specifically in PWH. Use of smallpox vaccines to prevent mpox is safe in PWH regardless of CD4+ cell count. There is limited data on efficacy in those with lower CD4+ cell count and on long-term protective efficacy.
PWH should be offered vaccination against mpox in line with national guidelines. PWH should be individually risk-assessed for severe mpox, based on their CD4+ cell count and co-morbidities and ideally recruited into treatment trials to build an evidence base on efficacy. HIV and other sexually transmitted infection testing should be offered to all people diagnosed with mpox.
2022 年全球猴痘爆发 disproportionately 影响了 HIV 感染者（PWH）。我们综述了关于 PWH 中猴痘的表现、治疗和预防的数据。
大多数患有猴痘的 PWH 都有轻度和自限性疾病，与没有 HIV 的人没有区别。据报道，PWH 和 HIV 疾病晚期患者的直肠症状发生率更高，他们患重病、住院和死亡的风险更高。抗病毒药物治疗在住院患者中广泛使用，但没有随机对照试验数据支持其使用，也没有专门针对 PWH 的数据。无论 CD4+细胞计数如何，使用天花疫苗预防猴痘在 PWH 中都是安全的。对于 CD4+细胞计数较低的人群和长期保护效果的数据有限。
应根据国家指南向 PWH 提供针对猴痘的疫苗接种。应根据 CD4+细胞计数和合并症对 PWH 中严重猴痘进行个体风险评估，并理想地招募他们参加治疗试验，以建立疗效的证据基础。应向所有诊断患有猴痘的人提供 HIV 和其他性传播感染检测。
