In a new study published in the journal HIV Medicine, German researchers evaluated the clinical characteristics of the Monkeypox Virus infection (MPXV) in people with and without infection of the human immunodeficiency virus (HIV).
Background
The 2017-2018 MPXV Nigeria plague has a case of 6%case. Four of the seven patients who died during this plague have obtained immunodeficiency syndrome (AIDS) or HIV infection. Thus, several studies, especially from Africa, raise fears that individuals infected with HIV are at an increased risk of contracting MPXV infections.
In the MPXV 2022 outbreak, the number of cases jumped across Europe and North America. For example, in Germany, 338 MPXV cases were confirmed reported to the Robert Koch Institute on June 17, 2022. Within a week, these cases were almost doubled, making Germany one of the most affected countries in the world. Nevertheless, researchers are not sure about the factors that threaten severe MPXV infections. In addition, the reasons for the current outbreak, the surge in case numbers, and the Kinetics of MPXV transmission are still unclear.
About the study
This study explores the possibility of a relationship between HIV and MPXV infections. Therefore, the German AIDS Society and German associations from outpattats for infectious diseases and HIV medicine asked all German health care centers to participate in this study. Furthermore, they asked them to retrospectively document all MPXV cases confirmed between May 19, 2022 and 30 June 2022.
All participating maintenance centers use anonymous questionnaires to collect study data. This data includes patient demographics, comorbidity, including HIV infection, the use of current pre-presentation of HIV, hepatitis B and C viruses previously or at this time, and sexually transmitted infections (IMS) in the last six months.
The researchers evaluated the diagnosis date confirmed from the MPXV infection and onset of symptoms, the possibility of the country affected by MPXV infection, the severity of the disease, location and number of lesions, previous smallpox vaccination, and general symptoms, such as fever, night sweat, swelling of the lymph nodes, lymph nodes swollen lymph nodes, lymph nodes swollen lymph nodes, and symptoms of lymph nodes of lymph nodes, and sweaty lymph lymph nights, lymph nodes .
The period of observation of short research, with a median of three days from the diagnosis of MPXV. Also, the average duration between the onset of symptoms and the diagnosis of MPXV is four days. A total of 298 patients were followed up for at least seven days from the onset of symptoms. In addition, the researchers carried out all diagnostic procedures, including the MPXV Polymerase (PCR) chain reaction, at the local German laboratory in participating centers or other laboratories from the National Institute of Robert Koch Germany in Berlin.
Study findings
This large retrospective study evaluates data from 546 MPXV cases confirmed by PCR from 42 participating health care centers. Research data includes nearly 50% of all 2022 MPXV cases reported in Germany. The worst German cities by MPXV are Berlin, Cologne, and Hamburg, with most cases among men having sex with men (MSM) either living with HIV or taking preparations. The authors recorded a total inpatient rate of around 4%, without significant differences observed in MSM with or without HIV. Most cases are dominated by mild to moderate, without death.
Interestingly, people infected with HIV identified in this study have good immunity, lower viral load (less than 200 copies/ml), and appear healthy despite MPXV infection infected. In addition, research has reported that children and pregnant women may be at higher risk of capturing MPXV infections. However, it seems that this population has not been present at the current outbreak.
Nearly 2/3 MPXV patients were diagnosed with at least one STI in the last six months, and 1/3 in one month or at the same time. This finding is very important and shows that MPXV or STI diagnosed with acute diagnosis must encourage diagnostic tests for other conditions. Also, 32.4% of all patients and 38.9% of Prep users have experienced gonorrhea for the past six months. In particular, the STI level is lower in MSM without HIV or Prep, with 47.6% of all patients do not have STIs in the last six months. Two other cohort studies from Madrid and London found the same level of STIs between MSMs with MPXV infections.
Smallpox vaccination provides protection against MPXV. Thus, individuals who are vaccinated in the research cohort have a relatively lighter MPXV clinical course. However, only four of the 22 patients were hospitalized for severe MPXV infection (18.2%) who received smallpox vaccination.
Interestingly, the localization of disease in the research cohort looks different from those observed during the 2017-2018 Nigeria MPXV. The manifestation of MPVX infection in cohort affects the face and stem but extremities at a lower level. Thus, 82.7% of patients have a maximum of 10 lesions, with only a few who have more than 50 lesions. In addition, MSM without HIV or Prep has a higher level of genital lesions and lower anal lesions.
Conclusions
All 546 participants in study with MPXV in this study were MSM with or without HIV. The authors observe there is no clinical difference in MPXV infection between MSM and or without HIV. Because most of the centers that participate focus on HIV and Prep infections, other affected groups may not be diagnosed or diagnosed in centers that do not participate in this study. In addition, most cases are mild. However, based on current outbreak kinetics, research findings show that MPXV appears as a new and serious STI.
Therefore, MSM which is sexually active, has skin lesions, especially with anogenital localization and other IMS history, must be tested immediately for MPXV. In addition, the education and awareness campaign must immediately overcome this problem between MSM, and all population set with high risk of contracting MPXV infections.