During previous mpox outbreaks, severe manifestations of disease and poor outcomes have been reported among people with HIV (PWH), particularly those with AIDS. During the 2022 outbreak, Centers for Disease Control and Prevention (CDC) staff provided clinical consultations for providers caring for patients with mpox and seeking to discuss clinical management or to access therapeutics under the emergency investigative new drug protocol. In this analysis, we sought to characterize the manifestations, outcomes, and HIV care-related considerations of mpox in hospitalized patients to inform care and guide ongoing outbreak response efforts.
This descriptive analysis assessed characteristics of all hospitalized patients aged >18 years with confirmed mpox infection for whom CDC was consulted between August 10-November 22, 2022. CDC obtained data on patient demographics, clinical course, and outcomes during consultation with health departments or providers.
Of 103 patients hospitalized with mpox infection, 100 (97%) were male, and the median age was 34.5 years (range = 20–61 years). Most patients were non-Hispanic Black (60%), and 22 (21%) were experiencing homelessness. Ninety (87%) had HIV infection; among these patients, 49 (58%) of 84 with a known CD4 count had < 50 CD4 cells/mm3. Of patients with HIV infection, 14 (16%) were receiving antiretroviral therapy (ART) before mpox diagnosis. Manifestations included dermatologic involvement (96, 93%), severe mucosal lesions (76, 74%), and involvement of the lungs (21, 20%), eyes (23, 22%), gastrointestinal system (5, 5%), and brain or spinal cord (four, 7%). Twenty-three (22%) patients received ICU-level care and 20 (19%) died.
Mpox infection in the current U.S. outbreak has been associated with severe morbidity and mortality, particularly among persons with AIDS. The disproportionate burden of severe mpox among persons of color and persons experiencing homelessness echoes inequities seen in the continuum of care for PWH. Providers should test sexually active patients with suspected mpox infection for HIV and other sexually-transmitted infections as indicated at the time of mpox testing. Engaging all PWH in care remains a critical public health priority, with additional efforts in HIV outreach and care retention needed to reduce the population at risk for severe mpox.
Disseminated lesions on the back and hands of a patient with severe monkeypox. Note: Patient has consented to the publication of these photographs. (Photos credit: Alexandra Dretler)