Instituto de Biomedicina de Sevilla (IBiS)/CSIC, Sevilla, Spain.
Grupo de Virología Clínica e ITS, Hospital Universitario Virgen de Valme, Sevilla, Spain.
J Med Virol. 2024 Mar;96(3):e29511. doi: 10.1002/jmv.29511.
To date, former research about the impact of HIV infection on mpox poor outcomes is still limited and controversial. Therefore, the aim of this study was to assess the impact of HIV on the clinical course of mpox, in a large population of patients from Spain. Nationwide case-series study. Patients from 18 Spanish hospitals, with PCR-confirmed mpox from April 27, 2022 to June 30, 2023 were included in this study. The main outcome was the development of long or complicated (LC) mpox, defined as: (i) duration of the clinical course ≥ 28 days, or; (ii) disseminated disease, or: (iii) emergence of severe complications. One thousand eight hundred twenty-three individuals were included. Seven hundred eighty-six (43%) were people living with HIV (PLWH), of whom 11 (1%) had a CD4 cell count < 200 cells/mm and 33 (3%) <350 cells/mm . HIV viral load ≥ 1000 cp/mL was found in 27 (3%) PLWH, none of them were on effective ART. Fifteen (60%) PLWH with HIV-RNA ≥ 1000 cp/mL showed LC versus 182 (29%) PLWH with plasma HIV-RNA load < 1000 copies/mL and 192 (24%) individuals without HIV infection (p < 0.001). In multivariate analysis, adjusted by age, sex, CD4 cell counts and HIV viral load at the time of mpox, only plasma HIV-RNA ≥ 1000 cp/mL was associated with a greater risk of developing LC mpox [adjusted OR = 4.06 (95% confidence interval 1.57-10.51), p = 0.004]. PLWH with uncontrolled HIV infection, due to lack of ART, are at a greater risk of developing LC mpox. Efforts should be made to ensure HIV testing is carried out in patients with mpox and to start ART without delay in those tested positive.
迄今为止，关于 HIV 感染对猴痘不良结局影响的研究仍有限且存在争议。因此，本研究旨在评估 HIV 对来自西班牙的大量患者猴痘临床病程的影响。
这是一项全国性病例系列研究。本研究纳入了 2022 年 4 月 27 日至 2023 年 6 月 30 日期间，18 家西班牙医院经 PCR 确诊的猴痘患者。主要结局为出现长或复杂（LC）猴痘，定义为：（i）临床病程≥28 天；或（ii）播散性疾病；或（iii）出现严重并发症。
共纳入 1823 名个体。786 名（43%）为 HIV 感染者（PLWH），其中 11 名（1%）CD4 细胞计数＜200 个细胞/mm3，33 名（3%）＜350 个细胞/mm3。27 名（3%）PLWH 的 HIV 病毒载量≥1000 cp/mL，他们均未接受有效的 ART。15 名（60%）HIV RNA≥1000 cp/mL 的 PLWH 出现 LC，而 182 名（29%）HIV RNA 载量＜1000 拷贝/mL 的 PLWH 和 192 名（24%）未感染 HIV 的个体则未出现 LC（p＜0.001）。多变量分析显示，在调整年龄、性别、CD4 细胞计数和猴痘时的 HIV 病毒载量后，仅 HIV 血浆 RNA≥1000 cp/mL 与出现 LC 猴痘的风险增加相关[调整比值比=4.06（95%置信区间 1.57-10.51），p=0.004]。由于缺乏 ART，HIV 感染未得到控制的 PLWH 发生 LC 猴痘的风险更高。应努力确保对猴痘患者进行 HIV 检测，并在检测结果为阳性的患者中立即开始 ART。
