By Myles Starr
The 2022 mpox outbreak put people with HIV (PWH) at higher risk for poor outcomes and severe disease than the general population. In response to a lack of drugs proven effective against the virus, the FDA approved the antiviral medicine tecovirimat (Tpoxx, SIGA Technologies) to treat the disease.
Data from a retrospective cohort study presented at CROI 2024, in Denver, suggest the drug was effective in helping PWH arrest the progression of mpox infections.
“For people living with HIV with known or suspected mpox, especially those with more advanced HIV or more severe mpox (e.g., mucosal involvement at presentation), starting tecovirimat within seven days of symptom onset appears to reduce the risk of mpox progression,” said study author Bruce Aldred, MD, an assistant professor in the Division of Infectious Diseases at Emory University School of Medicine, in Atlanta, who presented the results (poster 419).
One hundred twelve PWH diagnosed with mpox at four hospitals in Atlanta, between June 1 and Oct. 7, 2022, were included in the study. Half of the participants received tecovirimat within seven days of symptom onset and the other half was treated either later than seven days after symptom onset or did not receive tecovirimat. Mpox disease progression occurred in three PWH (5.4%) among patients administered tecovirimat in the first seven days of symptom onset compared with 15 PWH (26.8%) in the late or no tecovirimat group.
The study population was 54 of 56 (96.4%) cisgender males in both cohorts and two of 56 (3.6%) transgender females in both cohorts. Among participants, 109 of 112 (97.3%) reported having sex with cisgender male partners, and 84.8% identified as Black. No cisgender females or transgender males were included in the study, “which was simply due to the fact that these populations were much less affected by the 2022 mpox outbreak in the U.S.,” Dr. Aldred explained.
Researchers sought to balance covariates across the two matched cohorts to limit confounding. In the early tecovirimat group, the median age was 35 years; 54 individuals (96.4%) were cisgender men, 46 (82.1%) were Black and 10 (17.9%) listed other races. In the late or no tecovirimat group, the median age was 36 years; 54 (96.4%) were cisgender men, 49 (87.5%) were Black and seven (12.5%) reported other races or unknown race.
However, “it is possible that there could be relevant variables that were not included in the statistical models when creating the matched cohorts [and] RCTs [randomized control trials] on this topic are needed,” the researchers said.
Because the 2022 mpox outbreak has waned, Dr. Aldred’s team is not planning further work on this topic. However, when Dr. Aldred’s clinic sees sporadic cases of mpox, the patient is referred to the STOMP trial (stomptpoxx.org), a national RCT analyzing tecovirimat efficacy in people with mpox.
Dr. Aldred reported no relevant financial disclosures.
