Conclusion
The rapid global expansion of mpox cases during the 2022 outbreak
demonstrated how a zoonotic infection effectively transformed into a
sexually transmitted disease in the modern era. It is now clear that
PLWH who are poorly controlled are at significantly increased risk of
severe disease and death. Sporadic case clusters suggest ongoing
community transmission, though it remains to be seen if mpox will
ultimately become truly endemic. The natural progression of disease in
these severe cases, to include possible IRIS and risk factors for
progression other than low CD4 T Cell count, must be further clarified,
and optimal management remains undefined. While the STOMP trial and
VIRISMAP are actively attempting to answer these questions, low case
counts have slowed enrollment.
Therefore, until further data are available, we advise that the most
severe cases should be treated in consultation with the CDC, with
combination antiviral therapy, rapid initiation of ART and followed by a
multidisciplinary team to include a wound care specialist over the
prolonged course of the recovery. Those at risk should be vaccinated
with Jynneos. We also strongly encourage providers to enroll patients
into the STOMP trial and VIRISMAP to further define the natural course
of this disease and clarify optimal management strategies.