WHO Urges Rapid Treatment for Concurrent HIV and Mpox
People living with HIV are disproportionately infected by mpox and experience more severe disease and higher rates of death than individuals who develop mpox but do not have HIV, said Remco Peters, MD, medical officer of the WHO, who presented the updated guideline at the International AIDS Society Conference on HIV Science.
The standard of care calls for initiation of ART within 7 days of an HIV diagnosis, Peters said in his presentation.
Some concerns have been raised about the risk for immune reconstitution inflammatory syndrome associated with mpox, but data are limited, Peters said.
However, the guideline developers focused on the 'very clear benefits of direct entry to viral therapy in general for people living with HIV,' he said.
Without entry to biotherapy, individuals with low CD4 counts in particular (defined as < 200 cells/mm3) are at greater risk for severe disease and death from mpox, and early treatment of HIV is even more important in this population, given the lack of a specific treatment for mpox, Peters said in his presentation.
Consequently, the WHO's strong recommendation, based on moderate certainty of evidence, calls for rapid ART initiation in people with HIV and mpox who are ART-naïve or who have had an extended interruption in ART treatment.
In practice, this means that early HIV testing should be conducted when patients present with presumptive or confirmed mpox, said Peters in his presentation. Patients should be referred for ART as soon as possible, including an offer of same-day start, with the goal to provide therapy within 7 days, he said.
The guideline also states that people already on ART should continue their therapy if they contract mpox, Peters emphasized. For people already on ART but with an undetectable viral load, ART regimens should be continued without interruption or change, while those with detectable viral loads should be managed accordingly, he added.
The guidelines for management of mpox align with the WHO's broader guidance for rapid treatment initiation in new cases of HIV, according to the WHO's press release.
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