Most U.S. Mpox deaths occurred in highly HIV-infected black men

Most mpox-related deaths occurred in black cisgender men with advanced disease. HIV or AIDS People who report recent sexual contact with another man, according to CDC updates Weekly reports of morbidity and mortality.

Between May 10, 2022 and March 7, 2023, a total of 30,235 confirmed and probable cases of mpox were reported in the United States. During this time, 38 mpox-related deaths were recorded in the country, corresponding to his 1.3 mpox-related deaths per 1000 his cases.

The United States alone accounts for nearly one-third of all mpox-related deaths worldwide, with more than 87,000 cases in 110 countries, and 120 with 120 cases at the time of reporting, according to the report. is dead world health organization.

CDC has received reports that 52 individuals with confirmed or probable mpox have died in the United States, 38 of whom were classified as mpox-related. Three deaths have been confirmed not related to his mpox, and 11 deaths are still under investigation.

Of the 38 deaths from mpox in the United States, 87% were black, followed by whites (8%) and Latinos (5%). All but two were cisgender men, one was a cisgender woman, and one was a transgender woman. The CDC also reported that nearly half of the dead (47%) lived in southern states, compared with his 39.4% of local survivors.

“Gender and racial disparities in mpox-related deaths are consistent with previous reports, with most patients hospitalized with severe mpox symptoms being black men with uncontrolled HIV and HIV-infected. “In 2020, 75% of all deaths among HIV-infected adults will be male, of which 39% will be male. were black men.Disparities and barriers are evident at all levels of HIV care, including perception of HIV risk, access to testing, and access to and receipt of preexposure prophylaxis and ART. [antiretroviral therapy]”

Of the 10 deaths for whom recent sexual or intimate contact information was available, 9 had sexual or intimate contact with a cisgender male within 3 weeks before symptom onset. In addition, two of the deceased had close contact with her mpox patient, but not sexually, sharing a bed or caring for a family member, and for whom housing data are available. Five of her 11 deaths had experienced homelessness.

HIV infection was more common in deceased than in survivors, with available information indicating 87% of deceased and 45% of survivors, with HIV prevalence of 93.9% and 38.3%, respectively. Of her 24 HIV-infected deaths for whom information is available, all had very advanced HIV or AIDS and all but one had a CD4 count less than her 50. was. Her two other deceased were immunocompromised for other reasons, one experienced diabetic ketoacidosis and her other recently received a kidney transplant complicated by acute rejection.

Of the 25 HIV-infected individuals, only 2 reported receiving ART before being diagnosed with mpox, and 1 of these deaths had poorly controlled HIV. ART for her 19 of her 20 deaths that had not yet been received, including one she received an HIV diagnosis just five days after receiving the mpox diagnosis. started.

One deceased refused treatment for advanced HIV, and 3 of the 25 HIV-infected deceased had unknown ART treatment status. ART was delayed or interrupted for her 7 deaths due to clinician concerns about immune reconstitution inflammatory syndrome (IRIS). IRIS is a hyperinflammatory reaction that can occur in her HIV patient during her first six months on ART.

Current methods of preventing death from mpox include comprehensive testing, diagnosis and early treatment for mpox and HIV, ensuring equitable access to both mpox and HIV prevention and treatment, including ART. increase.

Clinicians chose not to administer mpox treatment to two of the fatalities. In one instance this was due to concerns about contraindications related to other comorbidities and in another the deceased was on ART for HIV with undetectable viral load at the time of initial evaluation of mpox care. A month later, the latter decedent was found dead during a medical examination, with diffuse lesions indicative of mpox. In addition, 7 of her 27 who died refused treatment or intravenous administration during clinical care, or were discharged against physician’s advice.

The median age at death (IQR) was 34 (22-58) years, and the median time from symptom onset to death was 68 (50-86) days. 2022. Of the 38 mpox-related deaths in the CDC report, 25 (65.8%) occurred between October and November 2022. Since then, both the number of cases and deaths have decreased significantly.

According to the authors, the report’s findings further underscore the importance of combining prevention, testing and treatment for sexually transmitted diseases such as mpox and HIV.

“Equitable access to mpox and HIV prevention, treatment and care participation and retention should be a priority, especially among black men and other people at risk of sexually transmitted infections,” said the authors. emphasized. “These results support previous recommendations that providers offer HIV testing to all patients with probable or confirmed mpox and consider early treatment toward mpox in severely immunocompromised patients. Furthermore, combining mpox therapy with enhanced immune function may also reduce mortality from severe mpox.”

reference

Riser AP, Hanley A, Cima M, et al. Epidemiological and clinical features of mpox-related deaths—United States, May 10, 2022–March 7, 2023. MMWR Morb Mortal Wkly Rep. 2023; 72:404–410. doi:10.15585/mmwr.mm7215a5