Almost all Americans hospitalized with monkeypox infection had weakened immune systems, most often due to HIV infection, the Centers for Disease Control and Prevention reported Wednesday.
Of the 57 hospitalized patients described in the report, 82% had HIV. More than two-thirds of patients were black and nearly a quarter were homeless, reflecting the racial and economic inequalities seen across the epidemic.
The finding suggests that although most cases of monkeypox are mild, doctors should also test patients with suspected HIV and be prepared to offer prompt treatment for both infections.
“Monkeypox and HIV have collided with tragic effects,” CDC senior monkeypox scientist Dr. Jonathan Mermin said in a statement.
Most patients in the study received tecovirimat, or Tpoxx, but some patients’ treatment was delayed for up to four weeks after first seeing them.
As of Tuesday, more than 28,000 cases of monkeypox had been reported in the United States and nearly 76,000 worldwide. A large majority are still among men who have sex with men, CDC says
The number of new monkeypox infections has declined steadily since September. But the number of high-risk people opting for vaccination has also fallen. Only 7% of vaccine doses given so far have gone to black recipients.
People living with HIV or other conditions that weaken the immune system have fared poorly in previous outbreaks of monkeypox in African countries.
In the new report, CDC scientists analyzed case reports from 57 patients over the age of 18 who were hospitalized with monkeypox between August 10 and October 10. About 95% of the patients were men.
All had rashes and most also had severe lesions of the mouth, urethra, rectum or vagina. About one in five patients had symptoms in the lungs and eyes, and in four patients the brain and spinal cord were affected.
Four of the 47 HIV-positive patients were taking drugs to suppress the virus before being diagnosed with monkeypox. About one in three had a CD4 count – an indicator of the strength of the immune system – below 50, indicating severe immunosuppression.
Two of the patients, one of whom had HIV, were being treated for cancer; three were solid organ recipients; and three were pregnant. All of these conditions are linked to a weakened immune system.
A third of the patients were admitted to intensive care units. Of the 12 recorded deaths, five were the result of complications from monkeypox infection, six are under investigation and one has been determined to be unrelated.
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