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Mpox Antiviral Outcomes Are Similar Regardless of HIV Status

Apr 11, 2023Apr 11, 2023

Mpox patients treated with tecovirimat, an antiviral drug widely used since last summer's outbreak, had similar outcomes regardless of HIV status, researchers at Columbia University's Vagelos College of Physicians and Surgeons and Weill Cornell Medicine have found.

"Columbia and Weill Cornell were two of the early sites in New York City to see patients with mpox, and there was a concern that persons with HIV and mpox would have worse outcomes," says Jason Zucker, MD, an infectious disease specialist at Columbia University Vagelos College of Physicians and Surgeons and co-leader of the study. "Our study suggests that patients with well-controlled HIV responded to tecovirimat treatment similarly to people without HIV."

During the outbreak, the CDC allowed for the use of tecovirimat (TPOXX) for people with severe mpox symptoms (through site-specific expanded access investigational new drug applications). The drug was originally developed and approved for the treatment of smallpox, a related virus, but had not been studied in people with mpox.

In the current study, the researchers analyzed data from 154 patients at Columbia and Weill Cornell who tested positive for mpox and were treated with tecovirimat between June and August 2022. Of those who were treated, 72 patients had HIV.

Nearly all patients, regardless of HIV status, were pain-free by the end of the treatment regimen. The drug was equally well tolerated in both patient groups.

The findings confirm results of other studies that show tecovirimat is well-tolerated, though additional studies are needed to establish the drug's effectiveness against mpox.

Zucker is vice chair of STOMP (Study of Tecovirimat for Human Monkeypox Virus), a multi-site randomized, placebo-controlled clinical trial sponsored by the CDC to study the effects of tecovirimat in a variety of populations with mpox.

Evidence has emerged that people who are severely immunocompromised, including those with poorly controlled HIV, are at greater risk for severe illness and death from mpox. "Only four people in the study had low CD4 counts, a sign of poorly controlled HIV, so we weren't able to compare treatment outcomes in that population," says Jacob McLean, DO, a postdoctoral clinical fellow in Columbia's Department of Medicine and first author of the study.

Visit the mpox page on the New York City Department of Health website for the latest information about the mpox vaccine, who's eligible for the vaccine, and where to find it.

"New York has better social safety programs for people with HIV compared with other states, so we have fewer patients with poorly controlled HIV," Zucker says. "There are wide disparities in access to care and treatment for people with HIV across the country and in other parts of the world, which feeds into the inequities in mpox diagnosis and treatment and affects outcomes."

Zucker adds that while the mpox outbreak has virtually ceased in the United States, cases are on the rise in other countries.

"We could see a resurgence of mpox if we don't make efforts to ensure that all vulnerable individuals are vaccinated," Zucker says.

Jason Zucker, MD, is assistant professor of medicine in the Division of Infectious Diseases at Columbia University Vagelos College of Physicians and Surgeons.

The study, titled ‘Tecovirimat Treatment of People with HIV During the 2022 Mpox Outbreak,’ was published online May 2 in Annals of Internal Medicine.

Marshall Glesby, MD, professor of medicine in the Division of Infectious Diseases at Weill Cornell Medicine, was co-leader of the study.

All authors: Jacob McLean (Columbia), Kate Stoeckle (Weill Cornell), Simian Huang (Columbia), Jonathan Berardi (Weill Cornell), Brett Gray (Columbia), Marshall J. Glesby (Weill Cornell), and Jason Zucker (Columbia).

The study was supported by grants from the National Institutes of Health (5T32AI100852-10, K23AI150378, UL1TR002384, UM1AI69419, and 5UM1AI069479-18).