Clinical Scorecard: Prolonged Mpox PCR Positivity for Over One Year in a Patient with Advanced HIV Infection
At a Glance
Category
Detail
Condition
Mpox infection with prolonged PCR positivity
Key Mechanisms
Persistent Orthopoxvirus DNA detection by PCR in skin lesions due to immunosuppression from advanced HIV
Target Population
Patients with advanced HIV/AIDS and low CD4+ counts
Care Setting
Inpatient and outpatient infectious disease and HIV care
Key Highlights
Mpox typically resolves within 4 weeks in immunocompetent patients but can persist over 1 year in advanced HIV infection.
Persistent Mpox PCR positivity was documented for more than 1 year in a patient with AIDS and very low CD4+ counts.
Treatment included prolonged oral tecovirimat and intravenous cidofovir with ART reinitiation; adverse effects such as cidofovir-induced uveitis occurred.
Guideline-Based Recommendations
Diagnosis
Confirm Mpox infection by molecular testing detecting Orthopoxvirus DNA via PCR from lesion swabs.
Management
Initiate antiviral therapy with oral tecovirimat for Mpox infection.
Consider intravenous cidofovir in refractory or persistent cases, especially in immunocompromised patients.
Restart or optimize antiretroviral therapy in patients with HIV/AIDS.
Monitoring & Follow-up
Perform serial Mpox PCR testing from skin lesions to monitor viral persistence and treatment response.
Monitor for adverse effects of antiviral therapies, including ocular toxicity with cidofovir.
Regularly assess CD4+ counts and HIV viral load to guide HIV management.
Risks
Prolonged viral shedding and persistence of Mpox lesions in immunocompromised patients.
Adverse effects of antiviral agents, such as cidofovir-induced anterior uveitis.
Potential for secondary bacterial infections in ulcerated lesions.
Patient & Prescribing Data
Advanced HIV patients with low CD4+ counts and persistent Mpox infection
Extended courses of tecovirimat (up to 6 months) and adjunctive cidofovir may be required; ART adherence is critical for immune recovery and viral clearance.
Clinical Best Practices
Ensure early diagnosis of Mpox via PCR testing in HIV-infected patients presenting with skin lesions.
Maintain close follow-up and adherence to ART to improve immune status and facilitate Mpox resolution.
Use prolonged antiviral therapy and monitor for treatment-related toxicities in persistent Mpox cases.
Manage secondary bacterial infections promptly to prevent complications.
Coordinate multidisciplinary care including infectious diseases, ophthalmology, and HIV specialists.
