CROI 2025 Abstract eBook

Abstract eBook

Poster Abstracts

1095 Mpox Viral Load and Illness Severity in MSM Living With and Without HIV by Vaccine Status Guido Schäfer 1 , Hauke Walter 2 , Knud Schewe 2 , Malte Monin 2 , Michael Sabranski 2 , Axel Adam 2 , Stefan Hansen 2 , Stefan Fenske 2 , Katharina Cron 2 , Christian Hoffmann 1 1 ICH Study Center, Hamburg, Germany, 2 ICH Hamburg, Hamburg, Germany Background: Due to a decline in Mpox cases after 2022 there is limited data on the effect of MVA BN vaccine (modified vaccinia Ankara vaccine, Bavarian Nordic) on Mpox disease severity, especially among people with HIV (PWH). During recent weeks the city of Hamburg (Germany) has faced a second wave of Mpox. Methods: All cases diagnosed at a single medical center in Hamburg in 2022 (n=121), 2023 (n=6) and 2024 (n=42) were grouped according to vaccine history. Disease severity was assessed by the 7-item Mpox Severity Scoring System (MPOX-SSS). As a surrogate of viral load, we used the cycle threshold (Ct) values of initial MPXV PCR swabs performed at different anatomical sites during the first two weeks after symptom onset. Results: Of 172 Mpox infections, 93 occurred in men who have sex with men (MSM) living with HIV (median CD4 504 cells/µl, 93% < 50 HIV-RNA copies/ ml) and 79 occurred in MSM without HIV. Mean age was 40 yrs and 93% had a history of other sexually transmitted infections (STI) while 31% had at least one additional STI prevalent at the time of Mpox diagnosis. Hospitalization rate was 3.0% and no death occurred. Vaccinated cases had lower MPOX-SSS scores compared to unvaccinated cases (Figure 1) and less fever (37 vs 63%, p=0.003) and headaches/chills (41 vs 65%, p=0.008). There were no differences between subjects with incomplete or complete vaccine courses. Scores and symptom rates did not differ between PWH and MSM without HIV. Median Ct values were lowest in rectal (22.6) and genital swabs (24.2) and highest in oropharyngeal swabs (31.5). Neither vaccine history, HIV infection, year of diagnosis, higher MPOX-SSS scores nor co-existing STIs were significantly associated with Ct values at different anatomical sites. However, in 3 Mpox re-infections, both MPOX-SSS scores and viral load appeared to be relatively low, compared to cases with first Mpox infection. Conclusions: Both incomplete and complete vaccine courses appear to reduce Mpox severity but not viral load in specimens. In the absence of severely immunocompromised cases, there were no differences regarding severity scores, symptoms or viral load between PWH and MSM without HIV.

risk to Californians and underscores the need to ensure accessible stigma-free prevention and care in the at-risk population.

1094 Long-Term Sequelae of Mpox: A Cohort Study in 2 Tertiary Centers Rene Bulnes 1 , Stephanie Reyes 1 , Shivani Sundar 1 , Tianna Petersen Petersen 1 , Mamta K. Jain 2 , Netanya Utay 3 1 UT Southwestern, Dallas, TX, USA, 2 Parkland Health and Hospital System, Dallas, TX, USA, 3 University of Texas Southwestern Medical Center, Dallas, TX, USA Background: The global outbreak of clade IIb Mpox Virus (MPXV) caused significant morbidity, particularly among men who have sex with men and persons living with HIV (PLWH). The medical, mental, and socioeconomic consequences of mpox remain unknown. Methods: We conducted a retrospective, longitudinal study using chart reviews and telephone questionnaires to evaluate the long-term effects of mpox. People diagnosed with mpox by PCR at our institutions were included, and HIV status was reviewed. Participants were administered questionnaires to assess persistent symptoms, socioeconomic effects, and mental health effects like anxiety, depression, and substance use. Scarring was evaluated using the Dermatology Life Quality Index (DLQI). The primary outcome included a composite of death, scarring, or persistent symptoms. We defined persistent symptoms as manifestations beyond scarring, like pain, sexual dysfunction, or fatigue. Logistic regression was used to analyze the associations between long term sequelae and baseline characteristics during acute mpox. Results: A total of 224 individuals were diagnosed with mpox, of whom 98.2% were male at birth, and 81.3% were PLWH. 16.2% required hospitalization, with four deaths attributed to mpox. Prospective analysis was conducted on the 64 individuals who could be reached, with an average follow-up of 19 months post diagnosis. Among these, 54.7% experienced the primary outcome. Scarring was reported by 40.6%, with 18.8% experiencing severe scarring that impacted their quality of life (DLQI score >10). Among PLWH, low CD4 counts (<200 cells/μL) and detectable VL were significantly associated with severe scarring (OR: 16.3 [95% CI: 3.2-82.9]; OR: 11.0 [95% CI: 2.7-45.4], respectively). Black individuals were more likely to experience the primary outcome (OR: 4.7 [95% CI: 1.6-14.0]), scarring (OR: 6.3 [95% CI: 2.1-19.0]), and severe scarring (OR: 5.2 [95% CI: 1.3-21.6]) compared to non-Black individuals. Socioeconomic challenges were reported by 51.6% and mental health effects by 34.4%, with no significant associations with baseline characteristics. Conclusions: PLWH with detectable viral loads and low CD4 counts face an increased risk of severe mpox and long-term sequelae, such as severe scarring, which can affect their quality of life. These outcomes are more prevalent among Black individuals, possibly reflecting disparities in healthcare access and usage. A systematic approach to addressing these long-term effects is essential for improving patient outcomes.

Poster Abstracts

1096 Impact of COVID-19 Healthcare Disruptions on ART Initiation and Viral Suppression: US, 2018-2021 Sarita Shah 1 , Felicia Hardnett 2 , Jun Li 2 , Alexander Ewing 2 , Brenna C. Hogan 3 , Vincent C. Marconi 4 , Jonathan Colasanti 4 , Catherine Lesko 5 , Adrienne E. Shapiro 6 , M. John Gill 7 , Maile Karris 8 , Joseph J. Eron 9 , Peter F. Rebeiro 10 , Keri N. Althoff 5 , Kate Buchacz 2 , for the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) of IeDEA 1 Rollins School of Public Health, Atlanta, GA, USA, 2 Centers for Disease Control and Prevention, Atlanta, GA, USA, 3 The Johns Hopkins University, Baltimore, MD, USA, 4 Emory University, Atlanta, GA, USA, 5 The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, 6 University of Washington, Seattle, WA, USA, 7 University of Calgary, Calgary, Canada, 8 University of California San Diego Medical Center, La Jolla, CA, USA, 9 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA, 10 Vanderbilt University Medical Center, Nashville, TN, USA Background: Rapidly initiating antiretroviral therapy (ART) and achieving viral suppression (VS) among newly diagnosed people with HIV (PWH)

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