The vast majority of hospitalized monkeypox patients observed in a report conducted by the Centers for Disease Control and Prevention (CDC) were found to be HIV-positive, bringing attention to the need for early treatment for those who have a high risk of developing a severe infection.
Between August and October of this year, the CDC provided clinical consultations for 57 patients who had developed severe cases of monkeypox. Of the patients who received consultations, 82 percent had HIV infections.
At 95 percent, the majority of patients were male and 68 percent were non-Hispanic Black. The CDC noted that 30 percent received intensive care unit (ICU) level care. About a quarter of the patients were experiencing homelessness.
Monkeypox was the cause or contributing factor for five the 12 patients who died in this report.
“Health care providers and public health professionals should be aware that severe morbidity and mortality associated with monkeypox have been observed during the current outbreak in the United States, particularly among highly immunocompromised persons,” the CDC said in its report.
HIV, which stands for human immunodeficiency virus, attacks the body’s immune system and can lead to AIDS if left untreated. The disease is currently incurable, but antiviral therapies are available which can suppress HIV activity to where it undetectable and untransmissible.
Reported monkeypox cases in the U.S. have been falling since they peaked in early August. The current seven-day moving average is 30 cases per day. Nearly all infections have occurred among men who have sex with men.
According to the most recent demographic data from the CDC, Black individuals currently account for the largest share of reported monkeypox cases at 44 percent. White individuals and Hispanic or Latino individuals account for the other two most impacted groups, with other ethnicities making up 1 to 2 percent of reported cases.
One patient who received a consultation from the CDC was described as a “Hispanic or Latino man in his 20s” who had no known medical history. The man had tested positive for HIV in 2020, but had ceased appearing for follow-up appointments according to the CDC’s report.
He was originally evaluated at an emergency department with back pain and a rash and was prescribed a course of prednisone, a common steroid medication often used for inflammation.
The rash tested positive for monkeypox and eventually spread over his entire body. He was soon admitted to a hospital with a nearly 103 degree fever, oral lesions and a mass on his neck.
The patient was moved to the ICU on his second day in the hospital, was intubated and the smallpox antiviral TPOXX was administered to him. Despite these measures, the patient died a few days after being transferred to the ICU.
As the CDC noted, the majority of cases of monkeypox resolve on their own, but cases can become severe among people who are immunocompromised. Some of the patients observed by the CDC in this report had waited up to four weeks from when they first sought treatment for monkeypox before they were given TPOXX.
The agency advised that providers should consider starting monkeypox-related therapies early for those at risk of severe disease and also potentially extend TPOXX beyond the standard 14 days it is usually administered.
“The occurrence of severe manifestations of monkeypox in patients who were most commonly immunocompromised because of AIDS highlights the importance of engaging all persons with HIV in sustained care and ending the HIV epidemic,” said the CDC.
