Is anyone else seeing human monkeypox hMPXV in their HIV patients? I identified 2 cases last week here in Eugene, OR in my clinic which is a mix of HIV, PrEP, sexual health, Hep C and also serves homeless/syringe exchange participants in the attached harm reduction site.
The first case had some prominent GI symptoms (diarrhea, abdominal bloating) 3 days after starting DAA therapy for HCV with GLE/PIB, he initially attributed his sx to that but when I spoke to him by phone he had developed a penile rash by Day 4. On exam he had multiple small (5mm or less) indurated ulcers with firm rolled edges similar to chancres, completely painless, there were a few with central umbilication similar to molluscum but when I unroofed one to sample it, could not express any purulent or casseous material. He did have painful inguinal adenopathy. The other case was his sexual partner who developed buttock rash and anorectal pain but did not have inguinal LAD, though I suspect had painful internal nodes.
The local health department started my patients on tecovirimat under the treatment IND from the CDC even though both are on ART and have stable CD4 above 500. I am assuming due to anogenital location of rash.
Just curious what other folks are seeing and if you have chosen to try to treat with tecovirimat and/or vaccinate to reduce disease severity. Has anyone seen people with severe illness from hMPXV?
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Rachel Picone DNP, FNP-C, AAHIVS
EUGENE OR
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