Associations between HIV and Severe Mpox in an Atlanta Cohort

Abstract

Abstract Background In the Southeastern U.S., the 2022 mpox outbreak disproportionately impacted people who are Black and people with HIV (PWH). Methods We analyzed a cohort of 395 individuals diagnosed with mpox across three healthcare systems in Atlanta, Georgia between 6/1/2022 and 10/7/2022. We present demographic and clinical characteristics and use multivariable logistic regression analyses to evaluate the association between HIV status and severe mpox (per the U.S. CDC definition) and, among PWH, the associations between CD4+ T cell count and HIV viral load with severe mpox. Results Of 395 people diagnosed with mpox, 384 (97.2%) were cisgender men, 335 (84.8%) identified as Black, and 324 (82.0%) were PWH. Of 257 PWH with a known HIV viral load, 90 (35.0%) were > 200 copies/mL. Severe mpox occurred in 77 (19.5%) individuals and there was 1 (0.3%) death. Tecovirimat was prescribed to 112 (28.4%) people, including 56 (72.7%) people with severe mpox. In the multivariable analysis of the total population, PWH had 2.52 times higher odds of severe mpox (95% CI 1.01-6.27) compared with people without HIV. In the multivariable analysis of PWH, individuals with HIV viral load > 200 copies/mL had 2.10 (95% CI 1.00-4.39) times higher odds of severe mpox than PWH who were virologically suppressed. Lower CD4+ T cell count showed a significant univariate association with severe mpox but was not found to be significantly associated with severe mpox in multivariable analysis. Lower CD4+ T cell count showed a significant univariate association with severe mpox but was not found to be significantly associated with severe mpox in multivariable analysis. Conclusions PWH with non-suppressed HIV viral loads had more mpox complications, hospitalizations, and protracted disease courses than people without HIV or PWH with suppressed viral loads. PWH with non-suppressed HIV viral loads who are diagnosed with mpox warrant particularly aggressive monitoring and treatment.