Clinical Characteristics and Treatments of Monkeypox Infections in Patients with HIV/AIDS

doi:10.19803/j.1672-8629.20240827

Abstract

Abstract: Objective To review the epidemiological features, clinical manifestations, treatments, and prevention strategies of monkeypox infections in patients co-infected with HIV/AIDS in order to enhance the ability of the medical staff to identify and treat such patients. Methods The epidemiological and clinical features of patients with HIV/AIDS co-infection with monkeypox are outlined. The drugs and vaccines currently used are summarized in terms of action mechanisms. Results Since 2022, monkeypox has erupted in multiple countries and regions globally, and HIV-infected individuals are at high risk of monkeypox virus infection. Currently, there are no effective vaccines or specific medications for monkeypox. Some small molecule drugs (tecovirimat, cidofovir and brincidofovi), immunoglobulins (VIG), and vaccines (MVA, MVA-BN) are showing promising antiviral effects in research and clinical trials. Conclusion Cases of monkeypox co-infection with HIV account for a high proportion of global outbreaks. Small molecule antiviral drugs, immunoglobulin, and proactive vaccination can serve as powerful weapons in controlling the outbreak.

Key words: Monkeypox, Monkeypox Virus, Men Who Have Sex with Men, HIV, AIDS, Small Molecule Drugs, Vaccinia Immune Globulin

CLC Number:

R994.11
R743

REN Bingqing, FAN Zibo, ZHANG Yuanyuan, ZHANG Wei, CHEN Zhihai. Clinical Characteristics and Treatments of Monkeypox Infections in Patients with HIV/AIDS[J]. Chinese Journal of Pharmacovigilance, 2024, 21(12): 1329-1336.

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https://zgywjj.magtechjournal.com/EN/Y2024/V21/I12/1329

References

[1] HUANG Y, MU L, WANG W.Monkeypox: Epidemiology, Pathogenesis, Treatment and Prevention[J]. Signal Transduct Target Ther, 2022, 7(1): 373.
[2] WHO. WHO Director-General's Statement at the Press Conference Following IHR Emergency Committee Regarding the Multi-Country Outbreak of Monkeypox-23 July 2022[EB/OL]. (2022-07-23)[2024-10-30]. https://www.who.int/news-room/speeches/item/who-director-general-s-statement-on-the-press-conference-following-IHR-emergency-committee-regarding-the-multi--country-outbreak-of-monkeypox--23-july-2022.
[3] WHO. WHO Director-General Declares Mpox Virus a Public Health Emergency of International Concern[EB/OL]. (2022-08-14)[2024-10-30]. https://news.un.org/en/story/2024/08/1153176.
[4] GIROMETTI N, BYRNE R, BRACCHI M, et al.Demographic and Clinical Characteristics of Confirmed Human Monkeypox Virus Cases in Individuals Attending a Sexual Health Centre in London, UK: An Observational Analysis[J]. Lancet Infect Dis, 2022, 22(9): 1321-1328.
[5] European Centre for Disease Prevention and Control/WHO Regional Office for Europe. Mpox, Joint Epidemiological Overview[EB/OL]. (2023-06-06) [2024-10-30]. https://monkeypoxreport.ecdc.europa.eu/.
[6] BRYER JS, FREEMAN EE, ROSENBACH M.Monkeypox Emerges On A Global Scale: A Historical Review and Dermatologic Primer[J]. J Am Acad Dermatol, 2023, 88(5): e259.
[7] KOWALSKI J, CIELNIAK I, GARBACZ-ŁAGOŻNA E, et al. Comparison of Clinical Course of Mpox among HIV-Negative and HIV-Positive Patients: A 2022 Cohort of Hospitalized Patients in Central Europe[J]. J Med Virol, 2023, 95(10) : e29172.
[8] PHILPOTT D, HUGHES CM, ALROY KA, et al.Epidemiologic and Clinical Characteristics of Monkeypox Cases-United States[J]. MMWR Morb Mortal Wkly Rep, 2022, 71(32): 1018-1022.
[9] PATEL A, BILINSKA J, TAM JCH, et al.Clinical Features and Novel Presentations of Human Monkeypox in A Central London Centre During the 2022 Outbreak: Descriptive Case Series[J]. BMJ, 2022, 378: e072410.
[10] MITJÀ O, ALEMANY A, MARKS M, et al.Mpox in People with Advanced HIV Infection: A Global Case Series[J]. Lancet, 2023, 401(10380): 939-949.
[11] O'SHEA J, FILARDO TD, MORRIS SB. Interim Guidance for Prevention and Treatment of Monkeypox in Persons with HIV Infection-United States, August 2022[J]. MMWR Morb Mortal Wkly Rep, 2022, 71(32): 1023-1028.
[12] CHO CT, WENNER HA.Monkeypox Virus[J]. Bacteriol Rev, 1973, 7(1): 1-18.
[13] TAQUET M, SKORNIEWSKA Z, DE DEYN T, et al.Cognitive and Psychiatric Symptom Trajectories 2~3 Years after Hospital Admission for COVID-19: A Longitudinal, Prospective Cohort Study in the UK[J]. Lancet Psychiatry,2024, 11(9): 696-708.
[14] CDC. Detection of Monkeypox Outbreak in August 2023[EB/OL]. (2023-09-08)[2024-09-30]. http://m.chinacdc/jkzt/crb/yl/hd_13044/qxx/20230908_269405.html.
[15] JEYARAMAN M, SELVARAJ P, HALESH MB, et al.Monkeypox: An Emerging Global Public Health Emergency[J]. Life (Basel), 2022, 2(10): 91-109.
[16] MILLER MJ, CASH-GOLDWASSER S, MARX GE, et al.Severe Monkeypox in Hospitalized Patients-United States[J]. MMWR Morb Mortal Wkly Rep, 2022, 71(44): 1412-1417.
[17] MA XY, ZHOU XY, YUAN H.Epidemiological Characteristics of Monkeypox Cases in Sichuan Province, 2023[J]. China Tropical Medicine(中国热带医学), 2024, 24(9): 1149-1152.
[18] YINKA-OGUNLEYE A, DALHAT M, AKINPELU A, et al.Mpox (Monkeypox) Risk and Mortality Associated with HIV Infection: a National Case-Control Study in Nigeria[J]. BMJ Glob Health, 2023, 8(11):e013126.
[19] DSOUZA VS, RAJKHOWA P, MALLYA BR, et al.A Sentiment and Content Analysis of Tweets on Monkeypox Stigma among the LGBTQ+ Community: A Cue to Risk Communication Plan[J]. Dialogues Health, 2023, 2: 100095.
[20] LIN M, XIN Y, WANG J, et al.Analyzing Monkeypox Epidemic Drivers: Policy Simulation and Multi-Index Modelling Across 39 Nations[J]. J Glob Health, 2024, 18(2): 177-188.
[21] MORAES-CARDOSO I, BENET S, CARABELLI J, et al.Immune Responses Associated with Mpox Viral Clearance in Men with and Without HIV in Spain: A Multisite, Observational, Prospective Cohort Study[J]. Lancet Microbe, 2024, 5(8): 100859.
[22] HOFFMANN C, JESSEN H, BOESECKE C.Monkeypox in Germany[J]. Dtsch Arztebl Int, 2022, 119(33-34): 551-557.
[23] ALPALHÃO M, SOUSA D, FRADE JV, et al. Human Immunodeficiency Virus Infection May be A Contributing Factor to Monkeypox Infection: Analysis of A 42-Case Series[J]. J Am Acad Dermatol, 2023, 88(3): 720-722.
[24] BETANCORT-PLATA C, LOPEZ-DELGADO L, JAÉN-SANCHEZ N, et al. Monkeypox and HIV in the Canary Islands: A Different Pattern in A Mobile Population[J]. Trop Med Infect Dis, 2022, 7(10): 318.
[25] ANGELO KM, SMITH T, CAMPRUBÍ-FERRER D, et al.Epidemiological and Clinical Characteristics of Patients with Monkeypox in the GeoSentinel Network: A Cross-Sectional Study[J]. Lancet Infect Dis, 2023, 23(2): 196-206.
[26] ROPER, RL, GARZINO-DEMO, A, DEL-RIO, C. Monkeypox (Mpox) Requires Continued Surveillance, Vaccines, Therapeutics and Mitigating Strategies[J]. Vaccine, 41(20), 3171-3177.
[27] HUGGINS J, GOFF A, HENSLEY L, et al.Nonhuman Primates are Protected from Smallpox Virus or Monkeypox Virus Challenges by the Antiviral Drug ST-246[J]. Antimicrob Agents Chemother, 2009, 53(6): 2620-2625.
[28] Centers of Disease Control and Prevention. Information for Healthcare Providers on Obtaining and Using TPOXX (Tecovirimat) for Treatment of Monkeypox[EB/OL]. (2022-08-18)[2024-10-26].https://www.cdc.gov/poxvirus/monkeypox/clinicians/obtaining-tecovirimat.html.
[29] JORDAN R, CHINSANGARAM J, BOLKEN TC, et al.Safety and Pharmacokinetics of the Antiorthopoxvirus Compound ST-246 Following Repeat oral Dosing in Healthy Adult Subjects[J]. Antimicrob Agents Chemother, 2010, 54: 2560-2566.
[30] HALANI S, LEONG D, WU PE.Tecovirimat for Monkeypox[J]. CMAJ, 2022, 194(46): E1573.
[31] SIEGRIST EA, SASSINE J Antivirals with Activity Against Mpox: A Clinically Oriented Review[J]. Clin Infect Dis, 2023, 76(1): 155-164.
[32] DESAI AN, THOMPSON GR, NEUMEISTER SM, et al.Compassionate Use of Tecovirimat for the Treatment of Monkeypox Infection[J]. Jama, 328(13): 1348-1350.
[33] SMITH, TG, GIGANTE CM, WYNN NT, et al.Tecovirimat Resistance in Mpox Patients, United States, 2022-2023[J]. Emerging Infectious Diseases, 2023, 29(12): 2426-2432.
[34] RUSSO AT, GROSENBACH DW, CHINSANGARAM J, et al.An Overview of Tecovirimat for Smallpox Treatment and Expanded Anti-Orthopoxvirus Applications[J]. Expert Rev Anti Infect Ther, 2021, 19(3): 331-344.
[35] FRENOIS-VEYRAT G, GALLARDO F, GORGÉ O, et al.Tecovirimat is Effective Against Human Monkeypox Virus in vitro at Nanomolar Concentrations[J]. Nature Microbiology, 2022, 7(12): 1951-1955.
[36] KHALIL A, SAMARA A, O'BRIEN P, et al. Monkeypox and Pregnancy: What do Obstetricians Need to Know?[J]. Ultrasound Obstet Gynecol, 2022, 60(1): 22-27.
[37] KARAN A, SHAH N, GARRIGUES JM, et al.Surveillance of Complicated Mpox Cases Unresponsive to Oral Tecovirimat in Los Angeles County, 2022[J]. J Infect Dis, 2024, 229(Suppl 2): 249-254.
[38] DE CLERCQ E.Cidofovir in the Treatment of Poxvirus Infections[J]. Antiviral Res, 2002, 55(1): 1-13.
[39] MAGEE WC, HOSTETLER KY, EVANS DH.Mechanism of Inhibition of Vaccinia Virus DNA Polymerase by Cidofovir Diphosphate[J]. Antimicrob Agents Chemother, 2005, 49: 3153-3162.
[40] ALDERN KA, CIESLA SL, WINEGARDEN KL, HOSTETLER KY.Increased Antiviral Activity of 1-O-Hexadecyloxypropyl-[2-(14)C] Cidofovir in MRC-5 Human Lung Fibroblasts is Explained by Unique Cellular Uptake and Metabolism[J]. Mol Pharmacol, 2003, 63: 678-681.
[41] HOSTETLER KY.Alkoxyalkyl Prodrugs of Acyclic Nucleoside Phosphonates Enhance Oral Antiviral Activity and Reduce toxicity: Current State of the Art[J]. Antiviral Res, 2009, 82(2): A84-A98.
[42] LALEZARI JP, DREW WL, GLUTZER E, et al.(S)-1-[3-Hydroxy-2-(Phosphonylmethoxy)Propyl]Cytosine (Cidofovir): Results of a Phase I/II Study of a Novel Antiviral Nucleotide Analogue[J]. J Infect Dis, 1995, 171: 788-796.
[43] CUNDY KC, LI ZH, LEE WA.Effect of Probenecid on the Distribution, Metabolism, and Excretion of Cidofovir in Rabbits[J]. Drug Metab Dispos, 1996, 24: 315-321.
[44] QUENELLE DC, COLLINS DJ, KERN ER.Efficacy of Multiple-or Single-Dose Cidofovir Against Vaccinia and Cowpox Virus Infections in Mice[J]. Antimicrob Agents Chemother, 2003, 47(10): 3275-3280.
[45] SMEE DF, GOWEN BB, WANDERSEE MK, et al.Differential Pathogenesis of Cowpox Virus Intranasal Infections in Mice Induced by Low and High Inoculum Volumes and Effects of Cidofovir Treatment[J]. Int J Antimicrob Agents, 2008, 31: 352-359.
[46] WEI H, HUANG D, FORTMAN J, et al.Coadministration of Cidofovir and Smallpox Vaccine Reduced Vaccination Side Effects but Interfered with Vaccine-Elicited Immune Responses and Immunity to Monkeypox[J]. J Virol, 2009, 83: 1115-1125.
[47] HUGGINS JW, MARTINEZ M, HARTMANN CJ, et al.17th International Conference on Antiviral Research in: Successful Cidofovir Treatment of Smallpox-Like Disease in Variola and Monkeypox Primate Models[J]. Antiviral Res, 2004, 62: A27-A90.
[48] CHAN-TACK K, HARRINGTON P, BENSMAN T.Benefit-Risk Assessment for Brincidofovir for the Treatment of Smallpox: U.S. Food and Drug Administration's Evaluation[J]. Antiviral Res, 2021, 195: 105182.
[49] QUINTANA-CASTANEDO L, TARIN-VICENTE EJ, CHILOECHES-FERNÁNDEZ C, et al. Recalcitrant Molluscum Contagiosum Successfully Treated with Intralesional Cidofovir in a Patient with HIV/AIDS[J]. Int J Dermatol, 2021, 60: 372-375.
[50] KHANI E, AFSHARIRAD B, ENTEZARI-MALEKI T.Monkeypox Treatment: Current Evidence and Future Perspectives[J]. Journal of Medical Virology, 2023, 95(1): e28229.
[51] GAO XU, PENG JE, LI XW, et al.Recent Research of Antiviral Drugs and Vaccines for Mpox[J]. Chinese Journal of Pharmacovigilance,2024, 21(1): 111-116.
[52] PARKER S, TOUCHETTE E, OBERLE C, et al.Efficacy of Therapeutic Intervention with an Oral Ether-Lipid Analogue of Cidofovir (CMX001) in a Lethal Mousepox Model[J]. Antiviral Research, 2008, 77(1): 39-49.
[53] HUTSON CL, KONDAS AV, MAULDIN MR, et al.Pharmacokinetics and Efficacy of a Potential Smallpox Therapeutic, Brincidofovir, in a Lethal Monkeypox Virus Animal Model[J]. mSphere. 2021, 6(1): e0092.
[54] CHITTICK G, MORRISON M, BRUNDAGE T, et al.Short-Term Clinical Safety Profile of Brincidofovir: A Favorable Benefit-Risk Proposition in the Treatment of Smallpox[J]. Antiviral Res, 2017, 143: 269-277.
[55] RAO AK, SCHRODT CA, MINHAJ FS, et al.Interim Clinical Treatment Considerations for Severe Manifestations of Mpox- United States, February 2023[J]. Morb Mortal Wkly Rep, 2023, 72(9): 232-243.
[56] KEMPE CH, BERGE TO, ENGLAND B.Hyperimmune Vaccinal Gamma Globulin, Source, Evaluation, and Use in Prophylaxis and Therapy[J]. Pediatrics, 1956, 18(2): 177-188.
[57] HOPKINS RJ, KRAMER WG, BLACKWELDER WC, et al.Safety and Pharmacokinetic Evaluation of Intravenous Vaccinia Immune Globulin in Healthy Volunteers[J]. Clin Infect Dis, 2004, 39(6): 759-766.
[58] WEBB E, RIGBY I, MICHELEN M, et al.Availability, Scope and Quality of Monkeypox Clinical Management Guidelines Globally: A Systematic Review[J]. BMJ Glob Health, 2022, 7(8): e009838.
[59] CONTAG CA, MISCHE L, FONG I, et al.Treatment of Mpox with Suspected Tecovirimat Resistance in Immunocompromised Patient, United States, 2022[J]. Emerg Infect Dis, 2023, 29(12): 2520-2523.
[60] THET AK, KELLY PJ, KASULE SN, et al.The Use of Vaccinia Immune Globulin in the Treatment of Severe Mpox, Virus Infection in Human Immunodeficiency Virus/AIDS[J]. Clin Infect Dis, 2023, 76(9): 1671-1673.
[61] WITTEK R.Vaccinia Immune Globulin: Current Policies, Preparedness, and Product Safety and Efficacy[J]. Int J Infect Dis, 2006, 10(3): 193-201.
[62] Centers for Disease Control and Prevention. Expanded Access IND Protocol: Use of Vaccinia Immune Globulin Intravenous (VIGIV, CNJ-016) for Treatment of Human Orthopoxvirus Infection in Adults and Children[EB/OL]. (2023-05-01)[2024-9-28]. https://www.cdc.gov/mpox/media/pdfs/2024/08/VIGIV-Protocol.pdf”.
[63] ALTMANN S, BRANDT CR, MURPHY CJ, et al.Evaluation of Therapeutic Interventions for Vaccinia Virus Keratitis[J]. J Infect Dis, 2011, 203(5): 683-690.
[64] FINE PE, JEZEK Z, GRAB B, et al.The Transmission Potential of Monkeypox Virus in Human Populations[J]. Int J Epidemiol, 1988, 17(3): 643-650.
[65] AKTER F, HASAN TB, ALAM F, et al.Effect of Prior Immunisation with Smallpox Vaccine for Protection Against Human Mpox: A Systematic Review[J]. Rev Med Virol, 2023, 33(4): e2444.
[66] LIU H, WANG W, ZHANG Y, et al.Global Perspectives on Smallpox Vaccine Against Monkeypox: a Comprehensive Meta-Analysis and Systematic Review of Effectiveness, Protection, Safety and Cross-Immunogenicity[J]. Emerg Microbes Infect, 2024, 13(1): 2387442.
[67] MAYR A, MUNZ E.Veränderung Von Vaccinevirus Durch Dauerpassagen in Hühnerembryofibroblasten-Kulturen Changes in The Vaccinia Virus through Continuing Passages in Chick Embryo Fibroblast Cultures[J]. Zentralbl Bakteriol Orig, 1964, 195(1): 24-35.
[68] MEYER H, SUTTER G, MAYR A.Mapping of Deletions in the Genome of the Highly Attenuated Vaccinia Virus MVA and Their Influence on Virulence[J]. J Gen Virol, 1991, 72( Pt 5): 1031-1038.
[69] STITTELAAR KJ, KUIKEN T, DE SWART RL, et al.Safety of Modified Vaccinia Virus Ankara (MVA) in Immune-Suppressed Macaques[J]. Vaccine, 2001, 19(27): 3700-3709.
[70] GRABENSTEIN JD, HACKER A.Vaccines Against Mpox: MVA-BN and LC16m8[J]. Expert Review of Vaccines, 2024, 23(1): 796-811.
[71] EARL PL, AMERICO JL, WYATT LS, et al.Immunogenicity of a Highly Attenuated MVA Smallpox Vaccine and Protection Against Monkeypox[J]. Nature, 2004, 428(6979): 182-185.
[72] FONTÁN-VELA M, HERNANDO V, OLMEDO C, et al. Effectiveness of Modified Vaccinia Ankara-Bavaria Nordic Vaccination in A Population at High Risk of Mpox: A Spanish Cohort Study[J]. Clin Infect Dis, 2024, 78(2): 476-483.
[73] MAZZOTTA V, LEPRI AC, MATUSALI G, et al.Immunogenicity and Reactogenicity of Modified Vaccinia Ankara Pre-Exposure Vaccination Against Mpox According to Previous Smallpox Vaccine Exposure and HIV Infection: Prospective Cohort Study[J]. E Clinical Medicine, 2024, 68: 102420.
[74] MONTANO M, SHAPIRO AE, WHITNEY BM, et al.Mpox in People with Human Immunodeficiency Virus: Predictors of Diagnosis, Outcomes, and Vaccine Effectiveness in A Multisite Cohort[J]. Clin Infect Dis, 2024, 78(2): 476-483.