北京17例HIV合并猴痘病毒感染者临床特征分析

Clinical characteristics of 17 cases of HIV with monkeypox virus infection in Beijing

目的分析北京地区HIV合并猴痘病毒(MPXV)感染者的临床表现、实验室检查及临床转归情况,为临床HIV合并MPXV感染者临床诊疗提供依据。方法对首都医科大学附属北京佑安医院感染与免疫医学科自2023年6-7月收治的17例HIV合并MPXV感染的患者,回顾性分析其流行病学特征、首发症状、临床表现、CD4细胞、HIV载量、cART情况及效果等情况。结果17例患者均为MSM,中位年龄30(26,33)岁,中位发病时间8(5,9)天,发病前均有男男性行为,仅有1例患者在幼年时期接种过天花疫苗,其他16例均未接种过天花疫苗。患者临床表现以皮疹(17例)、发热(15例)、淋巴结肿大(8例)为主,典型皮疹表现在生殖器、四肢、颜面、躯干等部位。17例患者中有15例已接受cART,12例cART时间超过5年,10例CD4细胞计数≥500个/μL,13例HIV RNA低于检测值下限。17例患者经对症治疗均已好转出院。结论临床上对于HIV合并MPXV感染者,尤其是CD4细胞<200个/μL的患者,务必给予足够重视。在有效防治MPXV感染方面,应优先为HIV感染者及MSM高危人群接种预防性疫苗,此外,对于未cART的HIV感染者及CD4细胞<200个/μL的人群进行积极健康宣教也至关重要。

Objective To analyze the clinical manifestations,laboratory tests,and clinical outcomes of HIV cases with monkeypox virus(MPXV)infection in Beijing,and to provide evidence for the clinical diagnosis and treatment of HIV cases with MPXV infection.Methods A retrospective study was conduct of 17 HIV cases with MPXV infection admitted to the Department of Infection and Immunology of Beijing You'an Hospital Affiliated to Capital Medical University,from June to July 2023.The epidemiological characteristics,initial symptoms,clinical manifestations,CD4+T lymphocyte count,HIV viral load,antiretroviral therapy(cART)status and efficacy were retrospectively analyzed.Results All of the 17 cases were men who have sex with men(MSM),with a median age of 30(26,33)years and a median time since onset of 8(5,9)days.Prior to onset,all cases engaged in male homosexual behavior.Only 1 case had been vaccinated against smallpox in childhood,while the other 16 cases had never been vaccinated.The predominant clinical manifestations were rash(17 cases),fever(15 cases),and lymph node enlargement(8 cases).Typical rashes were found on the genitals,limbs,face,trunk,and other areas.Of the 17 cases,15 had received cART and 12 of them for more than 5 years,10 had CD4^(+)T lymphocytes of≥500/μL,13 had HIV RNA expressions below the lower limit of detection.All 17 cases improved and were discharged after symptomatic treatment.Conclusions Clinical attention must be paid to HIV cases with MPXV,especially those with CD4^(+)T cells less than 200/μL.For effective prevention and treatment of MPXV infection,priority should be given to prophylactic vaccination of HIV-infected individuals and high-risk MSM.In addition,positive health education for HIV-infected individuals who are not on cART and whose CD4+T cells less than 200/uL is also crucial.