Introduction Since its global reemergence in 2022, monkeypox (mpox) has demonstrated increased incidence and severity among people with human immunodeficiency virus (HIV [PWH]). Predictors of mpox diagnosis, vaccination, and outcomes among PWH are limited. Methods We included PWH with primary care visits after 1 January 2022 at 9 US sites participating in the Centers for AIDS Research Network of Integrated Clinic Systems Network. We identified mpox diagnosed between 1 June 2022 and 31 May 2023, through a combination of polymerase chain reaction result, diagnosis code, and/or tecovirimat receipt. We examined validated clinical diagnoses, laboratory results, vaccine data, and patient reported outcomes. We evaluated relative risks (RR) of mpox diagnosis, hospitalization, tecovirimat treatment, and vaccine receipt. Findings Among 19 777 PWH in care, 413 mpox cases (all male sex at birth) occurred (2.2 cases/100 person-years). Age <40 years, geographic region, Hispanic/Latine ethnicity, lack of antiretroviral therapy, detectable HIV viral load, and recent bacterial sexually transmitted infection predicted mpox diagnosis. PWH with CD4 200–349 cells/mm3 were most likely to be hospitalized (adjusted RR, 3.20; 95% confidence interval: 1.44–7.09) compared to CD4 ≥500, but half as likely as those with CD4 <200 to receive tecovirimat. Overall, smallpox/mpox vaccine effectiveness of ≥1 vaccine was 71% (adjusted RR, 0.29; 95% confidence interval: .14–.47) at preventing mpox, and 86% or better with CD4 ≥350 or HIV viral suppression. Non-Hispanic Black PWH were less likely to be vaccinated than other racial/ethnic identities. Interpretation PWH not on antiretroviral therapy or with unsuppressed HIV were more likely to be diagnosed with, and hospitalized for, mpox. Mpox/smallpox vaccine effectiveness was high, inclusive of those with low CD4 count and HIV viremia.

中文翻译：

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人类免疫缺陷病毒患者的猴痘：多中心队列中诊断、结局和疫苗有效性的预测因子


引言自 2022 年在全球重新出现以来，猴痘 （mpox） 在人类免疫缺陷病毒 （HIV， PWH） 患者中的发病率和严重程度有所增加。PWH 中 mpox 诊断、疫苗接种和结局的预测因子有限。方法 我们纳入了 2022 年 1 月 1 日之后在参与综合诊所系统网络艾滋病研究中心研究网络的 9 个美国地点的 PWH 和初级保健就诊。我们通过聚合酶链反应结果、诊断代码和/或 tecovirimat 收据的组合，确定了 2022 年 6 月 1 日至 2023 年 5 月 31 日期间诊断的 mpox。我们检查了经过验证的临床诊断、实验室结果、疫苗数据和患者报告的结果。我们评估了 mpox 诊断、住院、tecovirimat 治疗和接种疫苗的相对风险 （RR）。结果 在接受护理的 19 777 名 PWH 中，发生了 413 例 mpox 病例 （出生时均为男性） （2.2 例/100 人年）。年龄 <40 岁、地理区域、西班牙裔/拉丁裔、缺乏抗逆转录病毒治疗、可检测到的 HIV 病毒载量以及近期细菌性传播感染可预测 mpox 诊断。与 CD4 ≥500 相比，CD4 200-349 个细胞/mm3 的 PWH 最有可能住院 （校正 RR，3.20;95% 置信区间：1.44-7.09），但接受 tecovirimat 的可能性是 CD4 <200 患者的一半。总体而言，≥1 疫苗的天花/mpox 疫苗预防 mpox 的有效性为 71%（调整后的 RR，0.29;95% 置信区间：.14–.47），CD4 ≥350 或 HIV 病毒抑制的有效性为 86% 或更高。非西班牙裔黑人 PWH 比其他种族/民族身份更不可能接种疫苗。解释未接受抗逆转录病毒治疗或未抑制 HIV 的 PWH 更有可能被诊断出患有 mpox 并住院。 Mpox/天花疫苗的有效性很高，包括 CD4 计数低和 HIV 病毒血症的患者。