Prolonged Mpox Disease in People With Advanced HIV: Characterization of Mpox Skin Lesions Article Swipe

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Immune system Monkeypox Immunology Immunofluorescence Antiretroviral therapy Virus Medicine CD8 Virology Viral replication Human immunodeficiency virus (HIV) Myeloid cells Biology Antibody Viral load Recombinant DNA Vaccinia Biochemistry Gene

Jesse O’Shea , Jason Zucker , Samuel D. Stampfer , Shama Cash‐Goldwasser , Faisal S. Minhaj , Alexandra W. Dretler , Justin Cheeley , Shaoli Chaudhuri , Stephanie M. Gallitano , Shauna Gunaratne , Melissa Parkinson , Brian Epling , David R. Morcock , Irini Sereti , Claire Deléage ·

YOU? · · 2023 · Open Access · · DOI: https://doi.org/10.1093/infdis/jiad532 · OA: W4389130210

We report 3 complicated and prolonged cases of mpox in people with advanced human immunodeficiency virus (HIV) not on antiretroviral therapy (ART) at mpox diagnosis. Multiple medical countermeasures were used, including prolonged tecovirimat treatment and immune optimization with ART initiation. Immunofluorescence of skin biopsies demonstrated a dense immune infiltrate of predominantly myeloid and CD8+ T cells, with a strong type I interferon local response. RNAscope detected abundant replication of monkeypox virus (MPXV) in epithelial cells and dendritic cells. These data suggest that prolonged mpox in people with advanced HIV may be due to ongoing MPXV replication, warranting aggressive medical countermeasures and immune optimization.