Background:
Thousands of mpox cases have been reported in the US since 2022, disproportionately affecting people with HIV (PWH), but epidemiologic data on mpox among PWH are limited. We examined demographic and clinical characteristics of PWH with mpox across the US in the Center for AIDS Research (CFAR) Network of Integrated Clinical Systems (CNICS) cohort.
Methods:
We studied all PWH in care at 9 CNICS sites and identified mpox cases based on: a positive mpox PCR value, a documented mpox diagnosis, or tecovirimat prescription without accompanying negative mpox PCR result between June-December 2022. We examined the most proximal CD4 count and HIV viral load (VL), as well as antiretroviral therapy (ART) status prior to mpox diagnosis. We used generalized linear models with Poisson distribution and robust variance to estimate associations of demographic and clinical characteristics with tecovirimat prescription and hospitalization within 2 weeks of mpox diagnosis, adjusting for age and site.
Results:
We identified 381 PWH who had mpox, all assigned male at birth, with median age of 39 years; 30.7% identified as non-Hispanic White, 22.3% as non-Hispanic Black, and 29.9% as Hispanic. A majority of mpox cases were prescribed ART (95%, Table), had undetectable HIV VL (77%), and a CD4 count ≥500 (55%) at mpox diagnosis. Most mpox diagnoses (77%) were confirmed by PCR and 13% of cases had received ≥1 doses of JYNNEOS vaccine prior to mpox diagnosis. PWH with mpox who had CD4 count <200 were twice as likely to receive Tecovirimat compared to those with CD4≥500 (adjusted prevalence ratio [aPR]: 2.0, 95% confidence interval [CI]: 1.5-2.8). Race/ethnicity, detectable HIV VL, and ART status were not associated with Tecovirimat receipt. Cases with lower CD4 count were more likely to be hospitalized within 2 weeks of mpox diagnosis compared to those with CD4 ≥500 (CD4<200:aPR: 2.1, 95%CI: 0.7-6.6; CD4 200-350: aPR: 2.6, 95% CI: 1.2-5.8); those not on ART were nearly 4 times more likely to be hospitalized (aPR: 3.9, 95% CI: 1.7-8.9) compared to those prescribed ART; and those with detectable HIV VL were twice as likely to be hospitalized (aPR: 2.1, 95% CI: 1.1-4.3) as those with viral suppression.
Conclusions:
Among PWH at HIV care centers across the US, we observed notable associations between CD4 count ≤350, detectable VL, lack of ART and hospitalization following mpox diagnosis, suggesting that immunologic risk may extend beyond those with CD4 <200, the threshold at which many PWH are prescribed tecovirimat.
