People living with HIV have accounted for 38–50% of those affected in the 2022 multicountry mpox outbreak. Most reported cases were in people who had high CD4 cell counts and similar outcomes to those without HIV. Emerging data suggest worse clinical outcomes and higher mortality in people with more advanced HIV. We describe the clinical characteristics and outcomes of mpox in a cohort of people with HIV and low CD4 cell counts (CD4 <350 cells per mm). A network of clinicians from 19 countries provided data of confirmed mpox cases between May 11, 2022, and Jan 18, 2023, in people with HIV infection. Contributing centres completed deidentified structured case report sheets to include variables of interest relevant to people living with HIV and to capture more severe outcomes. We restricted this series to include only adults older than 18 years living with HIV and with a CD4 cell count of less than 350 cells per mm or, in settings where a CD4 count was not always routinely available, an HIV infection clinically classified as US Centers for Disease Control and Prevention stage C. We describe their clinical presentation, complications, and causes of death. Analyses were descriptive. We included data of 382 cases: 367 cisgender men, four cisgender women, and ten transgender women. The median age of individuals included was 35 (IQR 30–43) years. At mpox diagnosis, 349 (91%) individuals were known to be living with HIV; 228 (65%) of 349 adherent to antiretroviral therapy (ART); 32 (8%) of 382 had a concurrent opportunistic illness. The median CD4 cell count was 211 (IQR 117–291) cells per mm, with 85 (22%) individuals with CD4 cell counts of less than 100 cells per mm and 94 (25%) with 100–200 cells per mm. Overall, 193 (51%) of 382 had undetectable viral load. Severe complications were more common in people with a CD4 cell count of less than 100 cells per mm than in those with more than 300 cells per mm, including necrotising skin lesions (54% 7%), lung involvement (29% 0%) occasionally with nodules, and secondary infections and sepsis (44% 9%). Overall, 107 (28%) of 382 were hospitalised, of whom 27 (25%) died. All deaths occurred in people with CD4 counts of less than 200 cells per mm. Among people with CD4 counts of less than 200 cells per mm, more deaths occurred in those with high HIV viral load. An immune reconstitution inflammatory syndrome to mpox was suspected in 21 (25%) of 85 people initiated or re-initiated on ART, of whom 12 (57%) of 21 died. 62 (16%) of 382 received tecovirimat and seven (2%) received cidofovir or brincidofovir. Three individuals had laboratory confirmation of tecovirimat resistance. A severe necrotising form of mpox in the context of advanced immunosuppression appears to behave like an AIDS-defining condition, with a high prevalence of fulminant dermatological and systemic manifestations and death. None.

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晚期 HIV 感染者中的 Mpox：全球病例系列

在 2022 年多国 MPOX 疫情中，艾滋病毒感染者占受影响人群的 38-50%。大多数报告的病例都是 CD4 细胞计数较高的人群，其结果与未感染 HIV 的人群相似。新数据表明，晚期艾滋病毒感染者的临床结果更差，死亡率更高。我们描述了一群 HIV 感染者和低 CD4 细胞计数（CD4 <350 个细胞/mm）的 MPOX 临床特征和结果。来自 19 个国家的临床医生网络提供了 2022 年 5 月 11 日至 2023 年 1 月 18 日期间 HIV 感染者确诊的 MPOX 病例数据。贡献中心完成了去识别化的结构化病例报告表，其中包括与艾滋病毒感染者相关的感兴趣变量并捕获更严重的结果。我们限制该系列仅包括 18 岁以上感染 HIV 且 CD4 细胞计数低于 350 个细胞/毫米的成年人，或者在 CD4 计数并不总是常规可用的环境中，临床上归类为美国中心的 HIV 感染的成年人疾病控制和预防 C 阶段。我们描述其临床表现、并发症和死亡原因。分析是描述性的。我们纳入了 382 个案例的数据：367 名顺性别男性、4 名顺性别女性和 10 名跨性别女性。纳入个体的中位年龄为 35 岁（IQR 30-43）岁。在mpox诊断时，已知有349人（91%）感染艾滋病毒；349 人中有 228 人（65%）坚持抗逆转录病毒治疗（ART）；382 人中有 32 人 (8%) 患有并发机会性疾病。CD4 细胞计数中位数为每毫米 211 个 (IQR 117-291) 个细胞，其中 85 名 (22%) 个体的 CD4 细胞计数低于每毫米 100 个细胞，94 名 (25%) 个体每毫米 CD4 细胞计数为 100-200 个细胞。总体而言，382 例中有 193 例（51%）的病毒载量无法检测到。CD4 细胞计数低于 100 个细胞/mm 的患者比 CD4 细胞计数超过 300 个细胞/mm 的患者更常见严重并发症，包括坏死性皮肤损伤 (54% 7%)、偶尔出现肺部受累 (29% 0%)结节、继发感染和败血症（44% 9%）。总体而言，382 人中有 107 人（28%）住院，其中 27 人（25%）死亡。所有死亡均发生在 CD4 细胞计数低于每毫米 200 个的人群中。在 CD4 计数低于 200 个细胞/毫米的人群中，HIV 病毒载量较高的人群死亡人数较多。在开始或重新开始 ART 的 85 人中，有 21 人 (25%) 被怀疑患有 MPOX 免疫重建炎症综合征，其中 21 人中有 12 人 (57%) 死亡。382 名患者中，有 62 名 (16%) 接受替科维马治疗，7 名 (2%) 接受西多福韦或布西多福韦治疗。三人经实验室确认对替考维马耐药。在高级免疫抑制的情况下，严重坏死性MPOX似乎表现得像艾滋病定义的病症，具有高发病率的暴发性皮肤病和全身表现以及死亡。没有任何。