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Disproportionate presentation of Mpox among people with HIV: A multicenter retrospective cohort study in Taiwan
Andrew Po-Liang Chen1, Chien-Yu Cheng2, Chun-Yuan Lee3
1Department of Critical Care Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, College of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan; Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan.
Background:
By June 2024, Taiwan reported 381 Mpox virus (MPXV) cases and one death. This study aims to analyze the characteristics and clinical presentations during the first outbreak of Mpox in Taiwan.
Methods:
The study was conducted across 16 hospitals and included patients aged 20 and older diagnosed with Mpox between May 2022 and March 2024. Data on demographics, symptoms, medication, vaccination history, and laboratory results were collected. Patients with HIV (PWH) were classified based on their HIV plasma viral load (PVL): undetectable viral load (UDVL) was defined as PVL<50 copies/ml, while detectable viral load (DVL) was higher. Statistical analyses examined differences among HIV-negative individuals, PWH with UDVL, and PWH with DVL, with P < .05 considered significant.
Results:
A total of 178 patients were analyzed; 99.4 % were male, with 94.9 % identifying as gay, bisexual, or men who have sex with men. Two-thirds were PWH, and among them, two-thirds had UDVL. PWH with UDVL showed a lower incidence of concurrent STIs compared to those with DVL (P < .05), with syphilis being the most common STI. The vaccination rate against MPXV was about 7 %, with only nine patients vaccinated prior to acquiring the infection. Symptoms often included fever, and infections predominantly affected the genitourinary system. The number of vesicles was significantly associated with PVL (P < .05), with UDVL patients exhibiting fewer vesicles and less confluent skin lesions than those with DVL.
Conclusion:
Most MPXV infections in Taiwan occur among PWH, particularly those with UDVL. Enhanced screening, vaccination efforts, and integrated STI testing are crucial in addressing this outbreak.
