Concern over new form of mpox
Wednesday February 22nd 2023
A new severe form of mpox has a high mortality rate in people with advanced HIV, researchers report today.
The threat is outlined in a case series published in *The Lancet* by an international group of clinicians led by Queen Mary University of London, UK.
They say this form of mpox, previously known as monkey pox, should be added to the World Health Organisation and US Center for Disease Control list of ‘AIDS-defining conditions’ because of its mortality risk.
Working with researchers at the Fight Infections Foundation in Barcelona, Spain, they describe the current multi-country outbreak, largely among men who have sex with men.
Overall, about 38% to 50% of people diagnosed with mpox have HIV, usually stable on HIV treatment. But for those with advanced HIV - CD4 cell count below 200 cells/mm - mpox infection may be more severe, causing widespread, large, necrotising skin lesions including occasionally lung lesions.
The new paper represents the largest global study on the new form. Information was taken on 382 people with advanced HIV disease and mpox. Mortality stands at about 15% for this group, as the disease appears to behave differently.
Lead author Professor Chloe Orkin and her team believe that adding the severe form of mpox to the existing list of AIDS-defining conditions will help health care professionals protect immunocompromised people.
They recommend that all people with mpox should be tested for HIV, and those with HIV and immunosuppression should be prioritised for vaccination.
Professor Orkin says: “Currently, there is a list of fourteen infections which behave differently and are particularly dangerous to immunosuppressed people with advanced HIV infection.
"Clinicians worldwide use this classification to guide their management of people most at risk of dying from these infections. We therefore call for mpox to be added to this list of ‘AIDS-defining conditions’ as it is an opportunistic infection."
Mitja, O. et al. Mpox in persons with advanced HIV infection: a global case series. *The Lancet* 21 February 2023; doi: 10.1016/S0140-6736(23)00333-1
Tags: Flu & Viruses | UK News | World Health
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