Prolonged Mpox PCR Positivity Over One Year in Advanced HIV Patient

Overview

This report describes a unique case of persistent Mpox infection with PCR positivity lasting over one year in a patient with advanced HIV and severe immunosuppression. Despite initial treatment with tecovirimat, the patient exhibited ongoing skin lesions and positive PCR results, which eventually resolved after extended antiviral therapy and ART reinitiation.

Background

Mpox, caused by the monkeypox virus, typically resolves within four weeks in immunocompetent individuals. The virus belongs to the Orthopoxvirus genus and has two main clades with differing fatality rates. Diagnosis is confirmed by detecting Orthopoxvirus DNA via PCR from lesion samples. Immunocompromised patients, such as those with advanced HIV, may experience atypical and prolonged disease courses.

Data Highlights

Key Findings

• Mpox PCR positivity persisted for over one year in a patient with advanced HIV and severe immunosuppression (CD4+ counts as low as 4 cells/µL).
• Initial 14-day oral tecovirimat treatment was insufficient to fully resolve Mpox lesions or clear viral DNA in this immunocompromised host.
• Extended antiviral therapy combining oral tecovirimat (6 months) and intravenous cidofovir (42 days) alongside ART reinitiation led to eventual PCR negativity and lesion resolution.
• Patient developed bilateral anterior uveitis attributed to cidofovir, necessitating discontinuation of this agent and corticosteroid eye drops.
• Mpox lesions showed gradual clinical improvement correlating with decreasing viral PCR positivity and immune recovery (CD4+ increase to 40 cells/µL).

Clinical Implications

Clinicians should be aware that Mpox infection in patients with advanced HIV may result in prolonged viral shedding and persistent lesions despite standard antiviral therapy. Extended antiviral treatment and strict adherence to ART may be necessary to achieve viral clearance. Monitoring for antiviral toxicities, such as cidofovir-induced uveitis, is important during prolonged therapy.

Conclusion

This case highlights the potential for prolonged Mpox PCR positivity and persistent infection in severely immunocompromised patients, underscoring the need for tailored, extended treatment strategies and close clinical monitoring in this population.

References

1. Prolonged Mpox PCR Positivity for Over One Year in a Patient with Advanced HIV Infection