Mpox can be fatal in some people with HIV, they find

Mpox can be fatal in some people with HIV, they find

Mpox can develop a much more serious condition in people with HIV who have a low count of CD4 cells (which are part of the immune system), even leading to a fatal outcome.

This was explained by scientists participating in the Conference on Retroviruses and Opportunistic Infections, the most prestigious conference on medical science around HIV. At the event, held in the city of Seattle, from February 19 to 22, a study was presented with data from 19 countries that followed up on 382 cases of mpox detected in the recent outbreak, which began in May 2022.

More serious cases

According to what was reported by the Working Group on HIV Treatments (gTt-HIV), the majority (90%) of the people monitored during the study were living with HIV and an infection by mpox was also detected.

Most people tested developed a rash, and the number, size, and extent of lesions were much more severe among people with low CD4 counts than among those with higher CD4 counts. Many people had severe skin lesions that caused tissue death, and some also developed lung involvement and sepsis (an extreme response of the body to infection).

It should be said that, of the population studied, only 60% were taking antiretroviral treatment, and only 7% had ever received the vaccine against smallpox.

In the investigation, published at the same time in the medical journal The Lancet, the death of 27 people was recorded, that is, 7% of the participating population. However, mortality was concentrated mainly among those with severely impaired immune systems.

Of the people who died, most had various serious smallpox-related complications, respiratory problems, and had CD4 counts of just 35 cells per milliliter of blood (when the count for someone in good health is at least 500 cells per milliliter).

According to research, this fulminant form of smallpox reported in people living with HIV with low CD4 counts is characterized by necrosis (death) of the skin around the lesions, skin lesions in the anal and genital area, and other parts of the body. body, lesions in mucosal areas, bacterial infections, eye damage and lung problems.

Having HIV under control reduces the risk

On the other hand, no deaths were recorded in anyone with well-controlled HIV infection or anyone who had been vaccinated against smallpox, suggesting that initiation and maintenance of antiretroviral therapy may prevent serious outcomes from mpox.

Dr Chloe Orkin, from Queen Mary University of London, one of the study co-authors, said that mpox acts as an opportunistic infection in people with uncontrolled HIV infection and that the severe necrotizing form is an AIDS-defining illness. This means that, in the opinion of the specialist, it should be considered that if a person with HIV develops severe mpox it means that they are in the AIDS stage.

For this reason, Dr. Orkin and other collaborators asked the World Health Organization (WHO) and the United States Centers for Disease Control (CDC) to add mpox to the list of other 14 opportunistic conditions listed in the international classifications of diseases.

Most deaths in America

Hospital centers from 6 Latin American countries participated in the research: Argentina, Brazil, Chile, Ecuador, Mexico and Peru. According to the results, of all the deaths that were registered in the study, the majority occurred in the American continent, so the researchers recommend that in countries with medium or low income, emphasis should be placed on monitoring people living with HIV and have mpox, as well as incorporating medicines and vaccines against smallpox in their health systems.

In addition, the experts recommended that all people with mpox and HIV and a CD4 count less than 200 cells/ml of blood receive a smallpox vaccine, as well as antiviral treatment, if available, despite the limited availability scientific evidence on its effectiveness. Even in the case of a case of mpox in a person not diagnosed with HIV, it is recommended to do a screening test for this and other sexually transmitted infections and a CD4 count.

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