Characterizing Risk Factors for Severe Mpox and Evaluating the Impacts of Mpox Vaccination among People with HIV and People with an Increased Likelihood of HIV Acquisition in Washington, DC
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We did not find an association between mpox proctitis and HPV, but we did find a high prevalence of both, showing a high-risk of HPV in the population at risk for mpox. Then, we found that a steeper increase in copy-years viremia is associated with an increased risk of mpox acquisition, showing longitudinal trends should be accounted for when evaluating risk. Finally, we found that mpox vaccination campaigns should target individuals with high sexual risk behaviors and be implemented in tandem with isolation protocols and partner reduction.
Severe manifestations of mpox have been found to be more common among people with HIV (PWH) and prior studies have found advanced HIV may be a risk factor for such outcomes. However, questions remain regarding the intersection between HIV and mpox and no models of mpox outbreaks have accounted for epidemiologic heterogeneity among PWH. Purpose
The first aim of this study was to evaluate whether HPV and sexual risk behaviors are associated with mpox proctitis among PWH or people with an increased likelihood of HIV acquisition. Our second aim was to determine whether longitudinal trends in HIV lab measures are associated with risk of mpox acquisition and severe mpox among PWH in Washington, DC. Our third aim was to evaluate the impact of mpox vaccination across different risk groups in a theoretical outbreak of mpox in Washington, DC. Methods
For our first aim, we collected data on presence of HPV, sexual risk behaviors, and mpox symptoms among PWH or people with an increased likelihood of HIV acquisition who recovered from mpox. Fisher’s exact tests, and Wilcoxon rank sum tests were used to evaluate differences in those with and without mpox proctitis. For our second aim, we conducted a nested case-control study among participants in a longitudinal HIV cohort and used two-stage and joint modeling to determine whether the slope of HIV lab measures was associated with mpox outcomes. To evaluate our third aim, we developed a Susceptible-Vaccinated-Exposed-Infectious-Recovered (SVEIR) compartmental model with six different risk strata accounting for sexual risk behaviors, HIV status, and level of CD4 in order to evaluate the impact of different vaccination scenarios on a theoretical outbreak in Washington, DC. Results
For our first aim, there were no significant differences in the prevalence of HPV among those with and without proctitis (p = 0.0709). Sexual risk behaviors did not differ between those with and without proctitis. For our second aim, we found that an increased slope of copy-years viremia was associated with an increased risk of mpox acquisition based on the joint modeling approach, even after adjusting for AIDS and known ARV regimen (Hazard Ratio (95% CI)
Background
1.11 (1.04, 1.18)). Trends in HIV lab measures were not associated with risk of severe mpox. For our third aim, we found that vaccinating 25% of individuals with high sexual risk behaviors was most optimal if vaccination is introduced immediately. However, implementation of isolation protocols and partner reduction measures resulted in vaccination having little effect on outbreak outcomes. Conclusions
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