Clinical characteristics of six fatal cases with advanced HIV and monkeypox virus co-infection in Beijing: A retrospective analysis.

Abstract

BACKGROUND: Recent findings on the outbreak of mpox indicate that immunosuppressed people are at significantly higher risk of death. The aims of the research were to provide a summary of the clinical features of mpox fatal cases, explore the effects of immunosuppression, monkeypox virus (MPXV)/human immunodeficiency virus (HIV) co-infection, and delayed antiretroviral therapy (ART) on prognosis, and offer evidence-based recommendations to inform clinical practices. METHODS: Demographic information, detailed HIV disease characteristics, ART history, mpox clinical features, laboratory results, and radiological evaluations were retrospectively extracted from electronic medical records. RESULTS: Six fatal cases were men who have sex with men (MSM), with a median age of 35 years (range: 23-37 years). Their median CD4count was 51 cells/μL (range: 2-116 cells/μL). Of these cases, two were simultaneously diagnosed with MPXV/HIV infection, one was diagnosed with HIV infection and never initiated ART, and the other three had interrupted ART prior to mpox diagnosis. All patients started or restarted ART, with a medium time from initiation of ART to death being 52 days (range: 20-148 days). Besides such symptoms like skin lesions and lymphadenopathy, all of them developed severe complications, including bacterial co-infections (n = 5), pneumonia (n = 5), intestinal obstruction (n = 2), and ocular involvement (n = 3). The median intervals between symptom onset and hospitalization or death were 30 days (range: 6-36 days) and 59 days (range: 32-110 days), respectively, with all death being due to sepsis or related multiple organ failure. CONCLUSION: The combination of MPXV with advanced HIV infection carries an excessive risk of death, generated by severe immunodeficiency that facilitates serious secondary infections and MPXV dissemination. Even if ART is initiated as soon as possible, immune function cannot be restored quickly enough to clear MPXV.