Department of Microbiology and Immunology, Faculty of Pharmacy, Helwan University, Cairo, Egypt.
Department of Biochemistry, Faculty of Pharmacy, Cairo University, Cairo, Egypt.
Virol J. 2024 Jun 5;21(1):130. doi: 10.1186/s12985-024-02392-0.
Limited data is available regarding the severity and mortality of Mpox in individuals with immunocompromised conditions. Therefore, we performed this meta-analysis to understand the impact of HIV- or non-HIV-associated immunosuppression on the severity of Mpox requiring hospitalization and mortality.
A thorough literature search was performed from 2022 up to January 2024. The results were presented as odds ratios (ORs). We only included patients who required hospitalization for severity rather than isolation.
A total of 34 studies were included in this analysis. Our analysis did not find a significant difference in the hospitalization risk between HIV-positive individuals and those who were HIV-negative (OR = 1.03; P = 0.85; 7 studies; CD4 count of fewer than 200 cells/µL was less than 0.5% across all studies). Patients with a CD4 count lower than 200 cells/µL or an unsuppressed RNA viral load (> 200 copies/ml) had a significantly higher hospitalization risk (OR = 5.3, P < 0.001) and (OR = 3, P < 0.001), respectively. Most of the reported deaths were reported in patients with HIV with CD4 counts below 200 cells/µL, with some fatal cases occurring in non-HIV immunosuppressed patients, particularly organ transplant recipients. Based on the autopsy findings, Mpox was confirmed in multiple organs, particularly the digestive tract, lung, and testes. Furthermore, some studies documented cases of death that were suspected to be related to hemophagocytic lymphohistiocytosis (HLH) and immune reconstitution inflammatory syndrome (IRIS). Most of the death reports showed concomitant non-Mpox infections at the time of hospitalization and death CONCLUSIONS: Our finding shows that Mpox acts as an opportunistic pathogen in immunocompromised individuals. These individuals should be prioritized for early care and closely monitored for signs of deteriorating clinical conditions. Clinical manifestations and autopsy findings strongly suggest Mpox dissemination to multiple organs, particularly the digestive tract, and lungs. However, the presence of concomitant non-Mpox infections complicates the assessment of the attribution of Mpox to death. Caution should be exercised when interpreting data suggesting poorer outcomes in individuals with non-HIV immunosuppression, as current evidence is scarce and further research is needed.
关于免疫功能低下个体中猴痘的严重程度和死亡率的数据有限。因此，我们进行了这项荟萃分析，以了解 HIV 相关或非 HIV 相关免疫抑制对需要住院治疗的猴痘严重程度和死亡率的影响。
从 2022 年到 2024 年 1 月进行了全面的文献检索。结果以比值比 (OR) 表示。我们只纳入了因病情严重而住院而非隔离的患者。
这项分析共纳入 34 项研究。我们的分析没有发现 HIV 阳性个体与 HIV 阴性个体的住院风险有显著差异（OR=1.03；P=0.85；7 项研究；所有研究中 CD4 计数<200 个细胞/µL 的比例均<0.5%）。CD4 计数<200 个细胞/µL 或未抑制的 RNA 病毒载量（>200 拷贝/ml）的患者住院风险显著升高（OR=5.3，P<0.001）和（OR=3，P<0.001）。大多数报告的死亡病例发生在 CD4 计数<200 个细胞/µL 的 HIV 患者中，少数非 HIV 免疫抑制患者也有致命病例，尤其是器官移植受者。根据尸检结果，猴痘在多个器官中得到证实，特别是消化道、肺和睾丸。此外，一些研究记录了疑似与噬血细胞性淋巴组织细胞增生症 (HLH) 和免疫重建炎症综合征 (IRIS) 相关的死亡病例。大多数死亡报告显示，住院和死亡时同时存在非猴痘感染。
我们的研究结果表明，猴痘在免疫功能低下个体中充当机会性病原体。这些患者应优先接受早期治疗，并密切监测病情恶化的迹象。临床表现和尸检结果强烈提示猴痘向多个器官扩散，特别是消化道和肺部。然而，同时存在非猴痘感染使评估猴痘对死亡的归因变得复杂。在解释非 HIV 免疫抑制个体预后较差的数据时应谨慎，因为目前证据有限，需要进一步研究。
