Inflammatory markers in MPOX and HIV co-infection during the 2022-23 outbreak, Dominican Republic

Abstract

Background: There is limited data to comprehend the clinical outcomes of MPOX (formerly monkeypox virus) infection in people living with HIV (PLWHIV), especially in low and middle- income (LMIC) countries during the 2022-23 outbreak. Previous studies have shown that immunocompromised status has been associated with a longer presentation and increasing the severity of the symptoms and mortality. This study is aimed to describe findings of co-infections in the DR. Methods: An observational analysis of cases with PCR-confirmed MPOX infection attending an HIV/STI clinic in Santo Domingo. Samples were analyzed November 2022-January 2023. Participant data were collected from medical records during hospitalization and follow-up. Results: • All participants were previously enrolled in HIV care and antiretroviral therapy, and self-identified as MSM with a mean age of 36.2 years. All developed systemic symptoms and skin lesions. • Distribution of pustules was more frequent in the face (perioral) and genital/anal region, and the involvement of hands and feet was not reported. (Figure 1A/B) • Fever and lymphadenopathies were reported in all cases. No other STIs were identified. Only one case required hospitalization and no fatalities were associated. Mean of effervescence manifestations was 24 days. • HIV viral load showed no modifications before and after infection, however, CD4/CD8 ratio was observed before and after the infection (mean 2.6) (Table 1). • Frequency of perioral lesions, and systemic manifestations were common among all cases. • Geographical distribution of HIV(+)/(-) and MPOX (+)/(-) or UNK contacts was analyzed (Figure 2). Conclusions: Pro-inflammatory reactions in MPOX infections observed in CD4:CD8 ratios might be of importance on outcomes and severity, and prolonged pustular stages. Public health actions to prevent mpox-HIV associated-deaths shall include integrated testing, diagnosis, and early treatment for mpox and HIV, and ensuring equitable access to both mpox and HIV prevention and treatment, such as antiretroviral therapy (ART).