Produção Nacional
Revisado por pares
Mpox in people with advanced HIV infection: a global case series
2023; Elsevier BV; Volume: 401; Issue: 10380 Linguagem: Inglês
10.1016/s0140-6736(23)00273-8
ISSN1474-547X
AutoresNatàlia Casamitjana, Andrea Alemany, Michael Marks, Jezer I Lezama Mora, Juan Carlos Rodríguez‐Aldama, Mayara Secco Torres Silva, Ever Arturo Corral Herrera, Brenda Crabtree‐Ramírez, José Luís Blanco, Nicolò Girometti, Valentina Mazzotta, Aniruddha Hazra, Macarena Silva, Juan José Montenegro-Idrogo, Kelly A. Gebo, Jade Ghosn, María Fernanda Peña Vázquez, Eduardo Matos Prado, Uche Unigwe, Judit Villar-García, Noah Wald‐Dickler, Jason Zucker, Roger Paredes, Alexandra Calmy, Laura Waters, Cristina Galván‐Casas, Sharon Walmsley, Chloe Orkin, Viviana Leiro, Lucila Marchetta, Patricia Fernandez Pardal, María Inés Figueroa, Pedro Cahn, Katharina Grabmeier‐Pfistershammer, Agnès Libois, Laurens Liesenborghs, Beatriz Grinsztejn, Mauro Schechter, Alberto dos Santos de Lemos, Alvaro Furtado Costa, Simone Queiroz Rocha, José Valdez Madruga, Darrell H. S. Tan, Sharmistha Mishra, Shreya Shah, Camila Jorquera, Alberto Castillo, Mauricio Carrión, Nelson Salas, Romain Palich, Valérie Pourcher, Emma Rubenstein, Pascal Migaud, Christoph Boesecke, Christian Hoffmann, Konstantinos Protopapas, Silvia Nozza, Anna Maria Cattelan, Cristina Mussini, Antonella d’Arminio Monforte, Raúl Adrian Cruz Flores, Edgar Pérez‐Barragán, Alma Leticia Rodríguez Guzmán, Dimie Ogoina, Nneka Marian Chika-Igwenyi, Chizaram Onyeaghala, Jenny Valverde López, Angelica García Tello, María Ubals, Martí Vall, Adrià Mendoza, Clara Suñer, Bonaventura Clotet, Jordi Bechini, José Antonio Lepe, Ma Dolores Navarro-Amuedo, José I Bernadino, Alba Català, Eloy José Tarín Vicente, Borja González Rodríguez, Sergi Rodríguez-Mercader, Francisca Sánchez-Martinez, Esperanza Cañas‐Ruano, Laura Parra‐Navarro, Finn Filén, Carmen Tallón de Lara, Dominique L. Braun, Vanja Piezzi, M. Burkhard, Helen Kovari, Anja Mönch, Jake Dunning, Pedro Simoes, Achyuta Nori, Sarah S. Keegan, John Thornhill, Vanessa Apea, Teymur Noori, Joyce Jones, Seth Judson, Elizabeth A. Gilliams, Matthew M. Hamill, Jeanne Keruly, Andrés F. Henao‐Martínez, Aung Lin, Jessica So, Kusha Davar, Diana Villareal, Miguel Tapia Paredes,
Tópico(s)Bacillus and Francisella bacterial research
ResumoBackgroundPeople living with HIV have accounted for 38–50% of those affected in the 2022 multicountry mpox outbreak. Most reported cases were in people who had high CD4 cell counts and similar outcomes to those without HIV. Emerging data suggest worse clinical outcomes and higher mortality in people with more advanced HIV. We describe the clinical characteristics and outcomes of mpox in a cohort of people with HIV and low CD4 cell counts (CD4 <350 cells per mm3).MethodsA network of clinicians from 19 countries provided data of confirmed mpox cases between May 11, 2022, and Jan 18, 2023, in people with HIV infection. Contributing centres completed deidentified structured case report sheets to include variables of interest relevant to people living with HIV and to capture more severe outcomes. We restricted this series to include only adults older than 18 years living with HIV and with a CD4 cell count of less than 350 cells per mm3 or, in settings where a CD4 count was not always routinely available, an HIV infection clinically classified as US Centers for Disease Control and Prevention stage C. We describe their clinical presentation, complications, and causes of death. Analyses were descriptive.FindingsWe included data of 382 cases: 367 cisgender men, four cisgender women, and ten transgender women. The median age of individuals included was 35 (IQR 30–43) years. At mpox diagnosis, 349 (91%) individuals were known to be living with HIV; 228 (65%) of 349 adherent to antiretroviral therapy (ART); 32 (8%) of 382 had a concurrent opportunistic illness. The median CD4 cell count was 211 (IQR 117–291) cells per mm3, with 85 (22%) individuals with CD4 cell counts of less than 100 cells per mm3 and 94 (25%) with 100–200 cells per mm3. Overall, 193 (51%) of 382 had undetectable viral load. Severe complications were more common in people with a CD4 cell count of less than 100 cells per mm3 than in those with more than 300 cells per mm3, including necrotising skin lesions (54% vs 7%), lung involvement (29% vs 0%) occasionally with nodules, and secondary infections and sepsis (44% vs 9%). Overall, 107 (28%) of 382 were hospitalised, of whom 27 (25%) died. All deaths occurred in people with CD4 counts of less than 200 cells per mm3. Among people with CD4 counts of less than 200 cells per mm3, more deaths occurred in those with high HIV viral load. An immune reconstitution inflammatory syndrome to mpox was suspected in 21 (25%) of 85 people initiated or re-initiated on ART, of whom 12 (57%) of 21 died. 62 (16%) of 382 received tecovirimat and seven (2%) received cidofovir or brincidofovir. Three individuals had laboratory confirmation of tecovirimat resistance.InterpretationA severe necrotising form of mpox in the context of advanced immunosuppression appears to behave like an AIDS-defining condition, with a high prevalence of fulminant dermatological and systemic manifestations and death.FundingNone.
Referência(s)