Barcelona (EFE).- International researchers led by the Fight Against Infections Foundation (FLI) of the Germans Trias i Pujol Hospital (Barcelona) and the Queen Mary University of London have identified a severe and necrotizing form of mpox (previously called monkeypox ) that causes death in 15% of immunosuppressed people with advanced HIV.
The FLI infectologist, Oriol Mitjà, has recommended that this severe form of mpox be added to the list of serious infections of the World Health Organization (WHO) and the Center for Disease Control, since they are particularly dangerous for people with HIV in advanced stages and have advised that all people with mpox be tested for HIV.
The research, published this Tuesday by The Lancet, has compiled the largest series of cases of mpox in people with advanced HIV disease, in which they identify a new severe form of mpox.
Most mpox infections in the current international outbreak have passed through sexual networks of gay, bisexual, and men who have sex with men, and 38-50% of people diagnosed with mpox in the past year are also living with HIV, the majority being treated with antiretrovirals and living disease-free lives.
The study certifies that monkeypox may be more serious in people with advanced HIV
Although doctors suspected that mpox infection may be more serious in people with advanced HIV, until now there has been no global study to certify this.
This work has analyzed the cases of 382 people with advanced HIV, of whom 107 were hospitalized and 27 died.
Thus, they have described a very severe form of mpox characterized by large and generalized necrotizing skin lesions, high rates of serious infections and, in some cases, unusual lung lesions.
This form of infection carries a mortality of 15% in people with advanced HIV disease and immunosuppressed and, as confirmed by the study, the 27 deaths occurred in this immunosuppressed group.
Therefore, researchers have called for adding this severe form of mpox to the existing list of AIDS-defining illnesses, to help physicians protect immunosuppressed people who are at higher risk of dying from monkeypox infection.
“All people with mpox should be tested for HIV, and all people at risk with HIV and immunosuppression should have priority in preventive vaccination against mpox and in access to antivirals”, requested Mitjà, who recalled that the Most deaths from mpox have occurred in countries with low levels of HIV diagnosis or without universal access to antivirals for mpox or HIV, and without access to intensive care units.
“A coordinated global effort is necessary to guarantee equitable access to antivirals and vaccines in countries where the interaction of uncontrolled HIV infection and mpox is more frequent”, said Mitjà.
Prioritize vaccination of people with HIV
According to the infectologist from the Foundation to Fight Infections and the Germans Trias i Pujol Hospital, “when doctors recognize necrotizing skin lesions or lung involvement, they must use a differentiated clinical pathway and an intensified approach, and the health authorities must prioritize vaccination of people living with HIV.
There is currently a list of 14 infections that behave differently and are particularly dangerous for immunosuppressed people with advanced HIV infection, and the researchers want this mpox to be included in this classification to guide management of people most at risk. of dying from these infections.
Prior to this work, the researchers had published three case studies on the recent global mpox outbreak: the first looks at mpox infection in men; the second describes the presentation of the disease according to its virology, epidemiology, pathogenesis or clinical presentation, and the third focuses on mpox infection in women and non-binary people.