Smallpox: A serious form of monkeypox threatens AIDS patients

Significant risk of death. A particularly serious form of monkeypox, also called “mpox”, has been identified in HIV-infected patients, up to and including death in those in the AIDS stage, according to a study released Tuesday.

“A severe and necrotizing form of smallpox (may be) similar to the disease characteristic of AIDS,” summarize the authors of this study, published in the Lancet.

The monkeypox epidemic that swept the world in 2022 before largely subsiding affected mostly men in homosexual relationships.

However, this is a population in which a large proportion of people are infected with HIV, the virus that triggers AIDS at a very late stage, affecting the patient’s immunity and making him vulnerable to a number of diseases.

“Thundering Mpox”

In this context, the researchers were interested in the particular risks that monkeypox poses to patients already infected with HIV. Thus, the authors of the study studied the case of almost 400 patients infected with both HIV and smallpox. In their case, they identified a very serious form of the disease, which they described as “fulminant smallpox.”

This form, which is aimed at patients with an advanced stage of HIV infection, leads to massive necrosis of the skin, genitals, and even lungs.

It caused the death of 27 patients. They all exceeded the threshold commonly used for AIDS: less than 200 CD4 T-lymphocytes per mm3 of blood. These deaths alone represent a significant proportion of the hundreds of deaths recorded in the context of the epidemic, out of several tens of thousands of cases.

For researchers, these findings should prompt health authorities to prioritize vaccinating people with HIV against smallpox. They are also calling for this severe form of smallpox to be added to the list of AIDS-defining illnesses. This includes about fifteen pathologies that are considered particularly dangerous in the case of advanced HIV infection.