Clinical Characteristics of Mpox and Mpox-HIV Coinfection in Lima, Peru: A Retrospective Multicenter Analysis

This study aimed to assess the clinical characteristics and outcomes of mpox and mpox-HIV coinfection in Lima, Peru, during the 2022-2023 outbreak. Also, it sought to identify predictors of hospitalisation, particularly related to HIV immunosuppression.

We conducted a retrospective analysis of 588 individuals with confirmed mpox across three public referral hospitals in Lima, Peru, between June 2022 and January 2023. Data were extracted from mpox surveillance forms, medical charts, and laboratory systems. Descriptive statistics and bivariate analyses were performed, followed by multivariate logistic regression to identify predictors of hospitalisation.

Among the 588 individuals with mpox, the mean age was 32.1 years, and 54.8% were people living with HIV (PLWH). Hospitalisation occurred in 8% of individuals, with a higher rate among PLWH (11.2%) compared to individuals without HIV (4.1%). Proctitis and a CD4 count < 500 cells/μL were significant predictors of hospitalisation (adjusted odds ratio [aOR]: 7.47 and 5.74, respectively). Lesion counts were lower in PLWH, and a distinct rash distribution was observed. Six deaths occurred, all in PLWH, with sepsis being the leading cause.

This study highlights the clinical differences of mpox between PLWH and people without HIV in Lima, with even mild HIV-related immunosuppression (CD4 < 500 cells/μL) and proctitis being key factors for hospitalisation. Deaths occurred exclusively in PLWH, emphasising the importance of managing HIV effectively to mitigate severe mpox outcomes. Strengthening HIV care and ensuring access to mpox treatment are critical in response strategies for future outbreaks.