Prolonged Mpox Disease in People With Advanced HIV: Characterization of Mpox Skin Lesions

Jesse O’Shea; Jason Zucker; Samuel Stampfer; Shama Cash-Goldwasser; Faisal S. Minhaj; Alexandra Dretler; Justin Cheeley; Shaoli Chaudhuri; Stephanie M. Gallitano; Shauna Gunaratne; Melissa Parkinson; Brian Epling; David R. Morcock; Irini Sereti; Claire Deleage

doi:10.1093/infdis/jiad532

Prolonged Mpox Disease in People With Advanced HIV: Characterization of Mpox Skin Lesions

Jesse O’Shea, Jason Zucker, Samuel Stampfer, Shama Cash-Goldwasser, Faisal S. Minhaj, Alexandra Dretler, Justin Cheeley, Shaoli Chaudhuri, Stephanie M. Gallitano, Shauna Gunaratne, Melissa Parkinson, Brian Epling, David R. Morcock, Irini Sereti, Claire Deleage

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

We report 3 complicated and prolonged cases of mpox in people with advanced human immunodeficiency virus (HIV) not on antiretroviral therapy (ART) at mpox diagnosis. Multiple medical countermeasures were used, including prolonged tecovirimat treatment and immune optimization with ART initiation. Immunofluorescence of skin biopsies demonstrated a dense immune infiltrate of predominantly myeloid and CD8+ T cells, with a strong type I interferon local response. RNAscope detected abundant replication of monkeypox virus (MPXV) in epithelial cells and dendritic cells. These data suggest that prolonged mpox in people with advanced HIV may be due to ongoing MPXV replication, warranting aggressive medical countermeasures and immune optimization.

Original language	English
Pages (from-to)	S243-S248
Journal	Journal of infectious diseases
Volume	229
DOIs	https://doi.org/10.1093/infdis/jiad532
Publication status	Published - 15 Apr 2024

Keywords

AIDS
HIV
monkeypox virus
mpox
orthopoxvirus

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10.1093/infdis/jiad532

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O’Shea, J., Zucker, J., Stampfer, S., Cash-Goldwasser, S., Minhaj, F. S., Dretler, A., Cheeley, J., Chaudhuri, S., Gallitano, S. M., Gunaratne, S., Parkinson, M., Epling, B., Morcock, D. R., Sereti, I., & Deleage, C. (2024). Prolonged Mpox Disease in People With Advanced HIV: Characterization of Mpox Skin Lesions. Journal of infectious diseases, 229, S243-S248. https://doi.org/10.1093/infdis/jiad532

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title = "Prolonged Mpox Disease in People With Advanced HIV: Characterization of Mpox Skin Lesions",

abstract = "We report 3 complicated and prolonged cases of mpox in people with advanced human immunodeficiency virus (HIV) not on antiretroviral therapy (ART) at mpox diagnosis. Multiple medical countermeasures were used, including prolonged tecovirimat treatment and immune optimization with ART initiation. Immunofluorescence of skin biopsies demonstrated a dense immune infiltrate of predominantly myeloid and CD8+ T cells, with a strong type I interferon local response. RNAscope detected abundant replication of monkeypox virus (MPXV) in epithelial cells and dendritic cells. These data suggest that prolonged mpox in people with advanced HIV may be due to ongoing MPXV replication, warranting aggressive medical countermeasures and immune optimization.",

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author = "Jesse O{\textquoteright}Shea and Jason Zucker and Samuel Stampfer and Shama Cash-Goldwasser and Minhaj, {Faisal S.} and Alexandra Dretler and Justin Cheeley and Shaoli Chaudhuri and Gallitano, {Stephanie M.} and Shauna Gunaratne and Melissa Parkinson and Brian Epling and Morcock, {David R.} and Irini Sereti and Claire Deleage",

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day = "15",

doi = "10.1093/infdis/jiad532",

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O’Shea, J, Zucker, J, Stampfer, S, Cash-Goldwasser, S, Minhaj, FS, Dretler, A, Cheeley, J, Chaudhuri, S, Gallitano, SM, Gunaratne, S, Parkinson, M, Epling, B, Morcock, DR, Sereti, I & Deleage, C 2024, 'Prolonged Mpox Disease in People With Advanced HIV: Characterization of Mpox Skin Lesions', Journal of infectious diseases, vol. 229, pp. S243-S248. https://doi.org/10.1093/infdis/jiad532

TY - JOUR

T1 - Prolonged Mpox Disease in People With Advanced HIV

T2 - Characterization of Mpox Skin Lesions

AU - O’Shea, Jesse

AU - Zucker, Jason

AU - Stampfer, Samuel

AU - Cash-Goldwasser, Shama

AU - Minhaj, Faisal S.

AU - Dretler, Alexandra

AU - Cheeley, Justin

AU - Chaudhuri, Shaoli

AU - Gallitano, Stephanie M.

AU - Gunaratne, Shauna

AU - Parkinson, Melissa

AU - Epling, Brian

AU - Morcock, David R.

AU - Sereti, Irini

AU - Deleage, Claire

PY - 2024/4/15

Y1 - 2024/4/15

N2 - We report 3 complicated and prolonged cases of mpox in people with advanced human immunodeficiency virus (HIV) not on antiretroviral therapy (ART) at mpox diagnosis. Multiple medical countermeasures were used, including prolonged tecovirimat treatment and immune optimization with ART initiation. Immunofluorescence of skin biopsies demonstrated a dense immune infiltrate of predominantly myeloid and CD8+ T cells, with a strong type I interferon local response. RNAscope detected abundant replication of monkeypox virus (MPXV) in epithelial cells and dendritic cells. These data suggest that prolonged mpox in people with advanced HIV may be due to ongoing MPXV replication, warranting aggressive medical countermeasures and immune optimization.

AB - We report 3 complicated and prolonged cases of mpox in people with advanced human immunodeficiency virus (HIV) not on antiretroviral therapy (ART) at mpox diagnosis. Multiple medical countermeasures were used, including prolonged tecovirimat treatment and immune optimization with ART initiation. Immunofluorescence of skin biopsies demonstrated a dense immune infiltrate of predominantly myeloid and CD8+ T cells, with a strong type I interferon local response. RNAscope detected abundant replication of monkeypox virus (MPXV) in epithelial cells and dendritic cells. These data suggest that prolonged mpox in people with advanced HIV may be due to ongoing MPXV replication, warranting aggressive medical countermeasures and immune optimization.

KW - AIDS

KW - HIV

KW - monkeypox virus

KW - mpox

KW - orthopoxvirus

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U2 - 10.1093/infdis/jiad532

DO - 10.1093/infdis/jiad532

M3 - Article

C2 - 38019806

SN - 0022-1899

VL - 229

SP - S243-S248

JO - Journal of infectious diseases

JF - Journal of infectious diseases

ER -

Prolonged Mpox Disease in People With Advanced HIV: Characterization of Mpox Skin Lesions

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