Early Mpox Antiviral Shows Promise in HIV Patients
Administering the antiviral tecovirimat (Tpoxx) within 7 days of mpox symptom onset is linked to reduced rates of mpox disease progression in individuals with HIV (PWH). ()
The cohort study, published in JAMA Internal Medicine, was based on outcomes seen among 112 PWH diagnosed as having mpox from June 1, to October 7, 2022. A total of 56 people were classified as cases and received tecovirimat within 7 days of mpox symptom onset (early tecovirimat group), and 56 were controls who were either treated later or did not receive tecovirimat at all (late or no tecovirimat group). In both the case and control groups, 96 percent of participants were cisgender men, and more than 80 percent were Black.The average age was 35 and 36, respectively among cases and controls.
‘There is apprehension that widespread tecovirimat use might lead to the development of a resistant virus. Additionally, mpox does not seem to manifest as a severe disease in otherwise healthy individuals with HIV. #AIDS #mpox’
The main outcome was progression of disease after 7 days. Mpox disease progression occurred in 3 PWH (5.4 percent) in the early tecovirimat group and in 15 PWH (26.8 percent) in the late or no tecovirimat group."Results of this cohort study support starting tecovirimat in all PWH as soon as an mpox diagnosis is suspected," said Bruce Aldred, from Emory University's School of Medicine in Georgia, in the paper."Additional research is warranted to confirm these findings," he added.
Although the findings are encouraging, a blanket recommendation to give Tpoxx to all PWH as soon as mpox is suspected may be premature given the limitations of tecovirimat availability, experts argued in an accompanying commentary, CIDRAP reported."The study shows the efficacy of Tpoxx, but ignores that most PWH in the US are not eligible for Tpoxx use based on current CDC guidelines, which would not include a PWH with undetectable viral loads," said experts from the universities of Columbia, North Carolina; and Cornell.The CDC recommendations currently include only PWH who have advanced or poorly controlled infection, as well as immunocompromised patients, children, and pregnant or breastfeeding women.
"Besides the practical issue that there is no clear path to obtaining tecovirimat treatment for all patients with HIV, there are reasons to favour limiting its use to those who would potentially benefit the most," Jason Zucker, from Columbia University.
Reference:
- Early Tecovirimat Treatment for Mpox Disease Among People With HIV - (https:pubmed.ncbi.nlm.nih.gov/38190312/)