HIV status does not impact mpox treatment with tecovirimat

1. In this retrospective study, tecovirimat was effective for treating mpox regardless of human immunodeficiency virus (HIV) status.

2. The incidence of adverse events was low regardless of HIV status in patients with severe mpox.

Evidence Rating Level: 2 (Good)

Study Rundown: Mpox is a zoonotic orthopoxvirus first described in the 1950s-1970s. In May 2022, an outbreak arose in Europe, resulting in cases in several countries. Those with HIV were thought to be disproportionately affected. Tecovirimat was an investigational drug indicated for the treatment of severe mpox during the initial outbreak. Notably, little was known about whether HIV status could impact treatment outcomes. The current retrospective study of 196 persons treated with tecovirimat in New York was stratified by participant HIV status. People living with HIV (PWH) and those without (HIV-negative) had similar treatment indicates, hospitalization rates, concurrent infections, and treatment outcomes. PWH had fewer days from symptom onset to treatment. The incidence of adverse events was low. The study was limited by the lack of a control group of mpox patients not treated with tecovirimat whose disease outcomes were well characterized. Furthermore, the study may be biased, as having HIV could be interpreted as an indication for tecovirimat. These results showed that tecovirimat was a promising treatment for mpox during the outbreak, regardless of HIV status.

Click to read the study in AIM

Relevant Reading: Summary for Patients: Population Genomic Screening for Three Common Hereditary Conditions

In-Depth [retrospective cohort]: This retrospective cohort study included 196 adults who received tecovirimat for mpox under the Centre for Disease Control (CDC) protocol between 20 June and 29 August 2022. Tecovirimat was indicated for treating severe mpox, symptoms of which included proctitis or rectal lesions, lesions involving urethra, and anatomically sensitive or confluent lesions. In total, 154 patients among the included participants tested positive for the mpox virus, 72 of whom were PWH and four who had a CD4 cell count lower than 0.20×10⁹ cells/L. The PWH and HIV-negative groups had similar hospitalization rates, treatment indications (the most common being proctitis), and concurrent infections. However, the PWH group had a significantly shorter time from symptom onset to treatment initiation (7.5 days) than the HIV-negative group (10 days). This difference persisted even in comparison to HIV-negative participants on pre-exposure prophylaxis. Both groups also had a similar median time until the first improvement (two days), pain resolution (Adjust Prevalence Ratio [APR], 1.1; 95% Confidence Interval [CI] 0.49 to 1.70), persistent symptoms (APR, 0.73; 95% CI, 0.28 to 1.18), and new lesion appearance after 48 hours (APR, 0.94; 95% CI ,0.53 to 1.35). Regarding the safety of tecovirimat, the rate of adverse events was low overall, with only four reporting serious adverse events. These results demonstrated the potential of tecovirimat for treating severe mpox, regardless of the patient’s HIV status.

Image: PD

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