e3a5120db7123228298ca783398e784b pmc_10673392.pdf 0ecdf0f0a8900940048d0dbbfc21d574dacf2283 pmc_10673392.pdf e8257375150bff0961fb93f234333665231fed4b85231f05644f964e12e898b8 pmc_10673392.pdf Title: Mpox: Clinical Outcomes and Impact of Vaccination in People with and without HIV: A Population-Wide Study Subject: We investigated differences in mpox clinical outcomes in people with HIV (PWH) and without HIV (PWoH) and the impact of vaccination in Catalonia, Spain. We used surveillance data and the PISCIS HIV cohort. We included all confirmed mpox cases (May–December 2022). Of 2122 mpox cases, the majority had mild disease, 56% were Spanish, and 24% were from Latin America. A total of 40% were PWH, with a median CD4+T-cell of 715 cells/L; 83% had HIV-RNA < 50 copies/mL; and 1.8% CD4+T-cell < 200 cells/L. PWH had no increased risk for complications, except those with CD4+T-cell < 200 cells/L. PWH with CD4+T-cell < 200 cells/L were more likely to be from Latin America, had more generalized exanthema, and required hospitalization more frequently (p = 0.001). Diagnosis of other sexually transmitted infections (STIs) was common, both at mpox diagnosis (17%) and two years before (43%). Dose-sparing smallpox intradermal vaccination was accompanied by a sharp decrease in mpox incidence in both populations (p < 0.0001). In conclusion, unless immunosuppressed, PWH were not at increased risk of severe disease or hospitalization. Mpox is a marker of high-risk sexual behavior and was associated with high HIV and STI rates, supporting the need for screening in all mpox cases. Ethnicity disparities demonstrate the need for interventions to ensure equitable healthcare access. Dose-sparing smallpox vaccination retained effectiveness. Keywords: mpox; sexually transmitted infections; HIV; immunosuppression Author: Raquel Martín-Iguacel, Carles Pericas, Andreu Bruguera, Gemma Rosell, Erica Martínez, Yesika Díaz, Lucia Alonso, Daniel Kwakye Nomah, Jose Luis Blanco, Pere Domingo, Patricia Álvarez-López, Maria Saumoy Linares, Consuelo Vilades Laborda, Arantxa Mera, Sonia Calzado Isbert, Isik Somuncu Johansen, José M. Miró, Jordi Casabona and Josep M. Llibre Creator: LaTeX with hyperref Producer: pdfTeX-1.40.21 CreationDate: Tue Nov 7 11:03:58 2023 CET ModDate: Wed Nov 8 02:08:18 2023 CET Custom Metadata: no Metadata Stream: no Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 14 Encrypted: no Page size: 595.276 x 841.89 pts (A4) Page rot: 0 File size: 1818930 bytes Optimized: no PDF version: 1.7 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- SXQPWE+VnURWPalladioL Type 1 Custom yes yes no 10 0 OVNEXW+EURM10 Type 1 Builtin yes yes no 15 0 VUNYNZ+URWPalladioL-Bold Type 1 Custom yes yes no 19 0 ZPMMJL+URWPalladioL-Roma Type 1 Custom yes yes no 24 0 YIFBJB+URWPalladioL-Ital Type 1 Custom yes yes no 28 0 QZKPTP+VnURWPalladioL-Bold Type 1 Custom yes yes no 32 0 SIXRFS+TimesNewRomanPS-BoldItalicMT Type 1C WinAnsi yes yes no 50 0 PDTLUH+CMSY10 Type 1 Builtin yes yes no 75 0 QLBIEB+URWPalladioL-BoldItal Type 1 Custom yes yes no 88 0 XIRVNA+EURB10 Type 1 Builtin yes yes no 101 0 Jhove (Rel. 1.28.0, 2023-05-18) Date: 2024-03-28 02:38:45 CET RepresentationInformation: pmc_10673392.pdf ReportingModule: PDF-hul, Rel. 1.12.4 (2023-03-16) LastModified: 2024-03-15 02:37:04 CET Size: 1818930 Format: PDF Version: 1.7 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf PDFMetadata: Objects: 245 FreeObjects: 1 IncrementalUpdates: 0 DocumentCatalog: PageLayout: SinglePage PageMode: UseNone Outlines: Item: Title: Introduction Destination: section.1 Item: Title: Materials and Methods Destination: section.2 Children: Item: Title: Setting Destination: subsection.2.1 Item: Title: Study Design and Data Sources Destination: subsection.2.2 Item: Title: Study Population Destination: subsection.2.3 Item: Title: Statistical Analysis Destination: section.3 Item: Title: Ethics Approval Destination: section.4 Item: Title: Results Destination: section.5 Item: Title: Discussion Destination: section.6 Item: Title: References Destination: section.A. Info: Title: Mpox: Clinical Outcomes and Impact of Vaccination in People with and without HIV: A Population-Wide Study Author: Raquel Martín-Iguacel, Carles Pericas, Andreu Bruguera, Gemma Rosell, Erica Martínez, Yesika Díaz, Lucia Alonso, Daniel Kwakye Nomah, Jose Luis Blanco, Pere Domingo, Patricia Álvarez-López, Maria Saumoy Linares, Consuelo Vilades Laborda, Arantxa Mera, Sonia Calzado Isbert, Isik Somuncu Johansen, José M. Miró, Jordi Casabona and Josep M. Llibre Subject: We investigated differences in mpox clinical outcomes in people with HIV (PWH) and without HIV (PWoH) and the impact of vaccination in Catalonia, Spain. We used surveillance data and the PISCIS HIV cohort. We included all confirmed mpox cases (May December 2022). Of 2122 mpox cases, the majority had mild disease, 56% were Spanish, and 24% were from Latin America. A total of 40% were PWH, with a median CD4+T-cell of 715 cells/L; 83% had HIV-RNA < 50 copies/mL; and 1.8% CD4+T-cell < 200 cells/L. PWH had no increased risk for complications, except those with CD4+T-cell < 200 cells/L. PWH with CD4+T-cell < 200 cells/L were more likely to be from Latin America, had more generalized exanthema, and required hospitalization more frequently (p = 0.001). Diagnosis of other sexually transmitted infections (STIs) was common, both at mpox diagnosis (17%) and two years before (43%). Dose-sparing smallpox intradermal vaccination was accompanied by a sharp decrease in mpox incidence in both populations (p < 0.0001). In conclusion, unless immunosuppressed, PWH were not at increased risk of severe disease or hospitalization. Mpox is a marker of high-risk sexual behavior and was associated with high HIV and STI rates, supporting the need for screening in all mpox cases. Ethnicity disparities demonstrate the need for interventions to ensure equitable healthcare access. Dose-sparing smallpox vaccination retained effectiveness. 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