CROI 2024 Abstract eBook

Abstract eBook

Poster Abstracts

423

Predictors of Treatment With Tecovirimat and Hospitalization Among People With Mpox and HIV Michalina Montano 1 , Adrienne E. Shapiro 2 , Rob Fredericksen 2 , Heidi M. Crane 2 , H. Nina Kim 2 , Richard D. Moore 3 , George A. Yendewa 4 , Laura Bamford 5 , Greer Burkholder 6 , Katerina Christopoulos 7 , Kenneth H. Mayer 8 , Sonia Napravnik 9 , April Pettit 10 , Mari Kitahata 2 , Rachel A. Bender Ignacio 2 1 Fred Hutchinson Cancer Center, Seattle, WA, USA, 2 University of Washington, Seattle, WA, USA, 3 The Johns Hopkins University School of Medicine, Baltimore, MD, USA, 4 Case Western Reserve University, Cleveland, OH, USA, 5 University of California San Diego, La Jolla, CA, USA, 6 University of Alabama at Birmingham, Birmingham, AL, USA, 7 University of California San Francisco, San Francisco, CA, USA, 8 Fenway Health, Boston, MA, USA, 9 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA, 10 Vanderbilt University, Nashville, TN, USA Background: Thousands of mpox cases have been reported in the US since 2022, disproportionately affecting people with HIV (PWH), but epidemiologic data on mpox among PWH are limited. We examined demographic and clinical characteristics of PWH with mpox across the US in the Center for AIDS Research (CFAR) Network of Integrated Clinical Systems (CNICS) cohort. Methods: We studied all PWH in care at 9 CNICS sites and identified mpox cases based on: a positive mpox PCR value, a documented mpox diagnosis, or tecovirimat prescription without accompanying negative mpox PCR result between June-December 2022. We examined the most proximal CD4 count and HIV viral load (VL), as well as antiretroviral therapy (ART) status prior to mpox diagnosis. We used generalized linear models with Poisson distribution and robust variance to estimate associations of demographic and clinical characteristics with tecovirimat prescription and hospitalization within 2 weeks of mpox diagnosis, adjusting for age and site. Results: We identified 381 PWH who had mpox, all assigned male at birth, with median age of 39 years; 30.7% identified as non-Hispanic White, 22.3% as non Hispanic Black, and 29.9% as Hispanic. A majority of mpox cases were prescribed ART (95%, Table), had undetectable HIV VL (77%), and a CD4 count ≥500 (55%) at mpox diagnosis. Most mpox diagnoses (77%) were confirmed by PCR and 13% of cases had received ≥1 doses of JYNNEOS vaccine prior to mpox diagnosis. PWH with mpox who had CD4 count <200 were twice as likely to receive Tecovirimat compared to those with CD4≥500 (adjusted prevalence ratio [aPR]: 2.0, 95% confidence interval [CI]: 1.5-2.8). Race/ethnicity, detectable HIV VL, and ART status were not associated with Tecovirimat receipt. Cases with lower CD4 count were more likely to be hospitalized within 2 weeks of mpox diagnosis compared to those with CD4 ≥500 (CD4<200:aPR: 2.1, 95%CI: 0.7-6.6; CD4 200-350: aPR: 2.6, 95% CI: 1.2- 5.8); those not on ART were nearly 4 times more likely to be hospitalized (aPR: 3.9, 95% CI: 1.7-8.9) compared to those prescribed ART; and those with detectable HIV VL were twice as likely to be hospitalized (aPR: 2.1, 95% CI: 1.1-4.3) as those with viral suppression. Conclusion: Among PWH at HIV care centers across the US, we observed notable associations between CD4 count ≤350, detectable VL, lack of ART and hospitalization following mpox diagnosis, suggesting that immunologic risk may extend beyond those with CD4 <200, the threshold at which many PWH are prescribed tecovirimat.

Background: The mpox 2022 outbreak was characterized by novel clinical presentation and new routes of transmission. We explored potential predictors of mpox severity and duration and described mpox virus (MPXV) persistence in relevant biological fluids after healing. Methods: Italian multicenter study in the network of Icona cohort. Severe mpox cases were defined as hospitalized or proctitis, pharyngotonsillitis, ocular lesion, or >20 skin lesions; recovery as the resolution of all mucocutaneous lesions. Mixed effect regression models with a random intercept for clinical center assessed predictors of mpox duration (linear model) and severity (logistic model). A stepwise backward process (with p=0.200) was fitted for the selection of variables in both multivariate models, using HIV status as a priori predictor. Assessment of early MPXV viral load (VL) as a predictor of severity was done by Student T-Test and mixed effect logistic regression model including random intercept on clinical center. Results: 541 pts: 99.2% male, median age 38 (IQR 33-44), 43,5% PLWH (see Fig1A). Mean mpox duration was 23.1 days (95% CI 21.9-24.3), significantly longer in pts with lymphadenopathy (+2.47 days), sore throat (+3.12), proctitis (+4.78), diffuse rash (+3.42) and in PLWH with <350 CD4 (+12.51) (Fig1B). Caucasian race (OR 1.82), fever (OR 1.95; p<0.002), lymphadenopathy (OR 2.30), sore throat (OR 2.14), and peri-anal lesions (OR 2.91) at onset were significantly associated with severe mpox (Fig1C). Quantitative determination of VL in the upper respiratory tract (URT) was available for 233 pts (136 mild and 97 severe). Mean Ct-value was 37.3 (33.9-40.8) and 34.6 (30.9-38.3) in mild and severe cases, respectively (P<0.005), and the probability of developing severe disease was inversely associated with Ct-value, dropping by 5% per Ct (OR 0.95; 0.91 0.98; p<0.005; Fig1D). We found no association between severity and VL in other fluids. Detectable MPXV was found in sperm (14/60 pts), urine (5/86), anorectal (10/72), and URT (24/160) up to 46 days after recovery with a minimum Ct value of 26. Conclusion: In the event of proctitis, sore throat, lymphadenopathy, and disseminated skin lesions, mpox may last longer, as well as in PLWH with a low CD4 count. Caucasian race and presentation with fever, sore throat, lymphadenopathy, and peri-anal lesions predicted disease severity directly associated with VL in URT. Still unclear if viral shedding after recovery in several anatomical sites could lead to persistent infectivity. Molecular Epidemiology of Human Mpox in Chicago Lacy M Simons , En-Ling Wu, Maureen Bolon, Timothy Blanke, Maria Francesca Agnes, Anjelo M. Evans, Arghavan Alisoltanidehkordi, Chad Achenbach, Valentina Stoser, Kendall Kling, Egon Ozer, Judd F. Hultquist, Ramon Lorenzo Redondo Northwestern University, Chicago, IL, USA Background: Mpox (formerly known as monkeypox) is a syndrome of fever, rash, and lymphadenopathy caused by the mpox virus (MPXV), a zoonotic double-stranded DNA orthopoxvirus. The virus was first isolated in monkeys from Singapore in 1959 and is now known to have several animal reservoirs. Since its emergence in humans in the 1970's, MPXV has become endemic in central and western Africa. In 2022, an outbreak of Mpox consisting of over 88 thousand cases across 113 countries prompted the World Health Organization to declare a public health emergency of international concern. High-risk populations for transmission were prioritized for vaccination with the JYNNEOS MPXV/smallpox vaccine. Global case counts peaked in early September of 2022 before tapering off in January 2023. In April 2023, a small resurgence of cases was noted in Chicago, including several vaccinated individuals, raising concerns of immune escape. Methods: In this study, we investigated the genetic variation and evolution of the virus throughout the 2022- 2023 outbreaks in Chicago. Between July 1, 2022 and September 1, 2023 residual diagnostic specimens were collected from Northwestern Memorial Hospital and affiliated clinics for DNA extraction and whole genome sequencing. In total, 139 specimens from 98 patients were collected, and 101 specimens from 77 patients were of sufficient viral load for whole genome sequencing. Results: We observed a rapid increase in viral population size and diversity peaking in August 2022, comprised of eleven lineages, indicative of a high degree of viral circulation. On the contrary, all of the 2023 cases belonged to the same lineage, B.1.20, defined by three synonymous mutations. These most likely arose from a single transmission cluster, which was supported by traditional epidemiological follow up.

Poster Abstracts

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424

Predictors of Mpox Duration and Severity in the Italian Multicenter Mpox Icona Cohort Valentina Mazzotta 1 , Silvia Nozza 2 , Simone Lanini 1 , Davide Moschese 3 , Alessandro Tavelli 4 , Roberto Rossotti 5 , Fusco Francesco Maria 6 , Lorenzo Biasioli 7 , Giulia Matusali 8 , Angelo Roberto Raccagni 2 , Davide Mileto 9 , Antonella D'Arminio Monforte 4 , Antonella Castagna 2 , Andrea Antinori 1 , for the Mpox-Icona Study Group 1 IRCCS Lazzaro Spallanzani, Rome, Italy, 2 San Raffaele Scientific Institute, Milan, Italy, 3 Luigi Sacco University Hospital, Milan, Italy, 4 Icona Foundation, Milan, Italy, 5 ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy, 6 AORN dei Colli, Naples, Italy, 7 Azienda Ospedaliera San Paolo, Milan, Italy, 8 Lazzaro Spallanzani National Institute for Infectious Diseases, Rome, Italy, 9 Fatebenefratelli Sacco Hospital, Milan, Italy

CROI 2024 104