Clinical characteristics of six fatal cases with advanced HIV and monkeypox virus co-infection in Beijing: A retrospective analysis

IF 4.8 3区医学 Q1 INFECTIOUS DISEASES

Journal of Infection and Public Health Pub Date : 2026-03-01 Epub Date: 2026-01-02 DOI:10.1016/j.jiph.2025.103126

Lulu Xing , Jialu Li , Yifan Guo , Ying Liu , Jiang Xiao , Hongxin Zhao

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引用次数: 0

Abstract

Background

Recent findings on the outbreak of mpox indicate that immunosuppressed people are at significantly higher risk of death. The aims of the research were to provide a summary of the clinical features of mpox fatal cases, explore the effects of immunosuppression, monkeypox virus (MPXV)/human immunodeficiency virus (HIV) co-infection, and delayed antiretroviral therapy (ART) on prognosis, and offer evidence-based recommendations to inform clinical practices.

Methods

Demographic information, detailed HIV disease characteristics, ART history, mpox clinical features, laboratory results, and radiological evaluations were retrospectively extracted from electronic medical records.

Results

Six fatal cases were men who have sex with men (MSM), with a median age of 35 years (range: 23–37 years). Their median CD4⁺ count was 51 cells/μL (range: 2–116 cells/μL). Of these cases, two were simultaneously diagnosed with MPXV/HIV infection, one was diagnosed with HIV infection and never initiated ART, and the other three had interrupted ART prior to mpox diagnosis. All patients started or restarted ART, with a medium time from initiation of ART to death being 52 days (range: 20–148 days). Besides such symptoms like skin lesions and lymphadenopathy, all of them developed severe complications, including bacterial co-infections (n = 5), pneumonia (n = 5), intestinal obstruction (n = 2), and ocular involvement (n = 3). The median intervals between symptom onset and hospitalization or death were 30 days (range: 6–36 days) and 59 days (range: 32–110 days), respectively, with all death being due to sepsis or related multiple organ failure.

Conclusion

The combination of MPXV with advanced HIV infection carries an excessive risk of death, generated by severe immunodeficiency that facilitates serious secondary infections and MPXV dissemination. Even if ART is initiated as soon as possible, immune function cannot be restored quickly enough to clear MPXV.

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北京地区6例晚期HIV伴猴痘病毒合并感染致死性病例临床特点回顾性分析

背景：最近关于麻疹暴发的调查结果表明，免疫抑制者的死亡风险明显更高。本研究旨在总结m痘致死性病例的临床特点，探讨免疫抑制、猴痘病毒(MPXV)/人类免疫缺陷病毒（HIV）合并感染和延迟抗逆转录病毒治疗（ART）对预后的影响，并为临床实践提供循证建议。方法回顾性提取电子病历中的人口统计信息、详细的HIV疾病特征、ART病史、mpox临床特征、实验室结果和影像学评价。结果6例死亡病例为男男性行为者（MSM），中位年龄35岁（范围23 ~ 37岁）。CD4+计数中位数为51个细胞/μL（范围2 ~ 116个细胞/μL）。在这些病例中，2例同时被诊断为MPXV/HIV感染，1例被诊断为HIV感染但从未开始抗逆转录病毒治疗，另外3例在m痘诊断之前中断了抗逆转录病毒治疗。所有患者开始或重新开始抗逆转录病毒治疗，从开始抗逆转录病毒治疗到死亡的中间时间为52天（范围：20-148天）。除皮肤病变、淋巴结病变等症状外，所有患者均出现严重并发症，包括细菌合并感染（n = 5）、肺炎（n = 5）、肠梗阻（n = 2）、眼部受累（n = 3）。从症状出现到住院或死亡的中位间隔时间分别为30天（范围6-36天）和59天（范围32-110天），所有死亡均因败血症或相关的多器官衰竭。结论MPXV合并晚期HIV感染具有过高的死亡风险，严重免疫缺陷导致严重继发感染和MPXV传播。即使尽早开始抗逆转录病毒治疗，免疫功能也不能迅速恢复到足以清除MPXV。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Infection and Public Health PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH -INFECTIOUS DISEASES

CiteScore

13.10

自引率

1.50%

发文量

203

审稿时长

96 days

期刊介绍： The Journal of Infection and Public Health, first official journal of the Saudi Arabian Ministry of National Guard Health Affairs, King Saud Bin Abdulaziz University for Health Sciences and the Saudi Association for Public Health, aims to be the foremost scientific, peer-reviewed journal encompassing infection prevention and control, microbiology, infectious diseases, public health and the application of healthcare epidemiology to the evaluation of health outcomes. The point of view of the journal is that infection and public health are closely intertwined and that advances in one area will have positive consequences on the other. The journal will be useful to all health professionals who are partners in the management of patients with communicable diseases, keeping them up to date. The journal is proud to have an international and diverse editorial board that will assist and facilitate the publication of articles that reflect a global view on infection control and public health, as well as emphasizing our focus on supporting the needs of public health practitioners. It is our aim to improve healthcare by reducing risk of infection and related adverse outcomes by critical review, selection, and dissemination of new and relevant information in the field of infection control, public health and infectious diseases in all healthcare settings and the community.