Early Treatment Recommended for Patients With HIV and Monkeypox

for Patients With HIV and Monkeypox An investigation of 57 patients hospitalized with severe monkeypox found that delayed treatment of men with HIV and monkeypox, particularly Black men, may have contributed to worse outcomes. The investigation provides insight into 57 severe monkeypox cases that CDC clinicians consulted on between August 10 and October 10, 2022. Three cases occurred among pregnant patients. All the other cases occurred among male patients; about two-thirds were Black men. Fortyseven individuals had HIV, almost threequarters had CD4 counts below 50, and only 4 received antiretroviral therapy before being diagnosed with monkeypox. Almost one-quarter of the patients were experiencing homelessness. Nearly all the patients received tecovirimat, but some experienced treatment delays of up to 4 weeks after initially seeking care for monkeypox symptoms. About one-third of the patients required intensive care unit admission. Six patients’ deaths were determined to be related to monkeypox, and the health authorities were still determining the cause of 6 additional deaths. The authors recommended that clinicians test all sexually active patients with suspected monkeypox for HIV, unless they have already been diagnosed with HIV, and initiate antiretroviral therapy immediately for those who test positive. They advised starting monkeypox treatment for immunocompromised patients with suspected monkeypox even before test results are available or severe symptoms emerge. They also recommended extending treatment longer than 14 days with tecovirimat for patients with severe or ongoing symptoms despite treatment. “These findings likely reflect inequities in access to resources for the prevention, early diagnosis, and treatment of HIV infection, as well as missed opportunities to engage groups that have been socially or economically marginalized,” the authors wrote. “Public health outreach should strive to engage all persons with HIV infection in care and to increase access to monkeypox vaccination, diagnosis, and treatment.” A second CDC report highlighted a successful effort by Georgia public health authorities to boost monkeypox vaccinations among Black men who have sex with men, who have been disproportionately affected by monkeypox in the state. The officials requested an additional allocation of JYNNEOS vaccine doses and administered them to 4282 individuals, about half of them Black individuals and about 8% Hispanic individuals, in the days before and during a Black gay pride festival in Atlanta.