编者按：2022年，全球约70个国家/地区报告了猴痘病例，这些国家/地区通常没有猴痘感染病例，而此前人与人之间的持续性猴痘传播主要发生在非洲。在近日举办的第12届国际艾滋病协会（IAS）HIV科学会议（IAS 2023）上，来自世界卫生组织（WHO）的Ana Hoxha教授带来了题为“HIV among mpox cases: clinical characteristics and outcomes in the WHO global surveillance 2022”的专题报告，报告基于WHO猴痘全球监测系统中的8.2万余例患者，详细描述了2022年猴痘病例中HIV感染者的临床特征和结局。《感染医线》在会议现场对Hoxha教授进行了采访。

 

01

《感染医线》：从WHO全球监测数据来看，猴痘在PLWHs中的流行情况如何？这两者在传播途径方面有何异同？

 

Hoxha教授：我想强调的是，猴痘监测数据仅包含猴痘病例。我们并未掌握HIV感染者的全部人数。因此，我们无法说明猴痘在HIV感染者中的流行情况。我们所知道的是，在感染猴痘的人群中，HIV的流行率是多少。根据我们所掌握的数据，在猴痘病例中，约有52%是HIV感染者。

 

关于传播途径的异同问题，我认为最初人们认为猴痘是一种通过接触传播的疾病，主要是直接接触病变部位和病变部位渗出的体液。在去年的暴发中，我们观察到了新特点，即在性接触过程中，人们会有密切的身体接触，这增加了感染猴痘的风险，但这其实在2017～2018年尼日利亚的暴发中已开始出现。我们知道，HIV的传播途径主要是通过体液交换传播，如精液、阴道分泌物等，因此HIV不是通过接触传播，不是与HIV感染者接触（就会感染HIV），同时HIV感染者也不会表现出病变，因此不会（因日常接触而）有感染风险。而对于猴痘，接触病变部位、病变部位渗出的体液、病变部位的结痂等就足以成为传播途径。

 

IDF: According to the WHO global surveillance data, how is the prevalence of mpox in PLWHs? What are the similarities and differences of the HIV and mpox transmission?

 

Dr. Hoxha: I want to highlight that the surveillance data of mpox contains only cases of mpox. We do not have all the number of people living with HIV. Therefore, we cannot say what is the prevalence of mpox among people living with HIV. What we know is what is the prevalence of HIV among people that got mpox, if it makes sense. So among our data that we have, we have cases of mpox. We know that around 52% of these cases are people living with HIV. Regarding the question on the differences and similarities between transmission, I think originally it was thought that mpox was a disease going through touch, mainly direct contact with the lesions and the fluids of these lesions. What is new in the last year outbreak, but it already had started coming up from the outbreak in 2017-2018 in Nigeria, is that during the sexual contact, people get close physical contact, and this enhances the risk for getting mpox. We know that the route of transmission of HIV is mainly through liquids, seminal liquids, vaginal liquids, secretions, therefore is not touch, is not contact with a person with HIV, because the person living with HIV will also manifest no lesions and therefore there will be no risk of getting infected. While with mpox we are talking about contact with the lesions, then liquids from the lesions, the crusts of the lesion would be a sufficient route of transmission.

 

02

《感染医线》：猴痘和HIV共感染患者的临床症状是否更严重，预后是否更差？

 

Hoxha教授：对于HIV已得到控制的HIV感染者，如果感染了猴痘，患者会出现皮肤病变和疼痛等症状，但这部分人群的预后与非HIV感染者没有什么区别。而对于HIV未得到控制的人群来说，一旦感染猴痘则需面临严重后果风险（包括住院和死亡），他们可能不知道自己感染了HIV，或者没有接受治疗，又或者所采取的治疗并未起效，因此而处于免疫力低下的状态。

 

IDF: Are the clinical symptoms and prognosis of patients coinfected with mpox and HIV more severe?

 

Dr. Hoxha: People living with HIV, that have a controlled HIV, if they get infected with mpox, they will have symptoms, they will have lesions, they will have pain, but the prognosis for them is not different than that of people not living with HIV. Those that are at risk of severe outcomes, including hospitalisation and death due to mpox, are people who live with uncontrolled HIV, meaning they don't know they have HIV and they are immunocompromised, they are not taking their treatment or their treatment somehow is not working, therefore they are in a status of immunocompromised status.

 

03

《感染医线》：CD4计数可以作为判断猴痘和HIV共感染患者预后的标志物吗？

 

Hoxha教授：从我们的数据来看还不能这么说，因为我们没有关于CD4计数的详细临床数据。但其他研究对病例的临床数据进行了更详细的研究，并进行了长期跟踪，结果表明，CD4计数低水平（＜200/μl）患者罹患重症猴痘的风险会增加。

 

IDF: Is there any prognostic marker for patients coinfected with mpox and HIV? like CD4 count or others.

 

Dr. Hoxha: From our data we cannot say that because we do not have detailed clinical data on CD4 count. But other studies that have been looking at more detailed clinical data of cases and have followed over time, they show that low CD4 counts under 200 showed an increased risk for severe mpox.

 

04

《感染医线》：鉴于猴痘和HIV共感染比较普遍，PLWHs是否需要有限接种猴痘疫苗？接种疫苗对ART是否有影响？

 

Hoxha教授：我们目前还不清楚猴痘疫苗与ART之间是否存在相互作用，因此还无法对此作出评价。目前，我们建议高危人群接种猴痘疫苗，其中也包括HIV感染者，尤其是性生活活跃、有多个性伴侣或未知性伴侣的人群。

 

IDF: As the high prevalence of coinfection with mpox and HIV, does PLWHs need to prioritize vaccination against monkeypox? Does vaccination have an impact on ART?

 

Dr. Hoxha: We don't know, we don't think that at this point in time there is a co-interaction, an interaction of mpox vaccines and ART treatment, so we cannot say anything about that. The mpox vaccine is at the moment recommended for high risk groups, which include also people living with HIV, especially if they are highly sexually active, if they have multiple partners, unknown partners.

 

 

Ana Hoxha

 

WHO突发卫生事件规划

 

流行病学家

 

曾在欧洲疾病预防与控制中心（ECDC）工作，主要研究抗菌药物的使用和耐药性问题，还曾在南非的无国界医生组织（MSF）工作，主要研究艾滋病和结核病。

 

往期推荐

 

IAS 2023丨猴痘有哪些后遗症？HIV是否增加猴痘住院风险？

 

来源：《感染医线》

 

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