Table 4.
Comparison of clinical presentations, treatment, and outcomes among patients with confirmed monkeypox with HIV and without HIV reported to GeoSentinel (May 1–July 1, 2022)
| Patients without HIV (n=134) | Patients with HIV (n=92) | p value* | |||
|---|---|---|---|---|---|
| History of smallpox vaccination | 9/92 (10%) | 7/90 (8%) | 0·87† | ||
| Signs and symptoms (patient reported) | |||||
| Rash or skin lesions anywhere on the body | 79 (59%) | 58 (63%) | 0·54 | ||
| Fever (subjective or measured) | 75 (56%) | 56 (61%) | 0·46 | ||
| Genital and or perianal lesions | 71 (53%) | 53 (58%) | 0·49 | ||
| Fatigue (malaise) | 57 (43%) | 36 (39%) | 0·61 | ||
| Enlarged lymph nodes | 49 (37%) | 33 (36%) | 0·91 | ||
| Sore throat (pharyngitis) | 27 (20%) | 27 (29%) | 0·11 | ||
| Chills | 25 (19%) | 25 (27%) | 0·13 | ||
| Headache | 20 (15%) | 15 (16%) | 0·78 | ||
| Muscle aches (myalgia) | 19 (14%) | 13 (14%) | 0·99 | ||
| Rectal pain | 18 (13%) | 15 (16%) | 0·55 | ||
| Sweats | 10 (85) | 10 (11%) | 0·38 | ||
| Cough | 9 (7%) | 7 (8%) | 0·80 | ||
| Itching (pruritis) | 9 (7%) | 9 (10%) | 0·40 | ||
| Back pain | 4 (3%) | 6 (7%) | 0·32† | ||
| Pus or blood in stool | 4 (3%) | 2 (2%) | 1† | ||
| Rectal bleeding | 4 (3%) | 4 (4%) | 0·72† | ||
| Urgency to defecate (tenesmus) | 4 (3%) | 6 (7%) | 0·32† | ||
| Pain with urination (dysuria) | 3 (2%) | 1 (1%) | 0·65† | ||
| Runny nose (rhinitis) | 3 (2%) | 2 (2%) | 1† | ||
| Diarrhoea | 2 (2%) | 11 (12%) | 0·002 | ||
| Oedema | 2 (2%) | 0 | 0·52† | ||
| Nausea | 2 (2%) | 1 (1%) | 1† | ||
| Abdominal pain | 1 (1%) | 0 | 1† | ||
| Red eyes (conjunctivitis or keratitis) | 1 (1%) | 1 (1%) | 1† | ||
| Eye lesions | 0 | 0 | .. | ||
| Shortness of breath | 0 | 0 | .. | ||
| Wheezing | 0 | 0 | .. | ||
| Vomiting | 0 | 0 | .. | ||
| None | 0 | 1 (1%) | 0·41† | ||
| Other‡ | 9 (7%) | 2 (3%) | 0·21† | ||
| Physical examination | |||||
| Documented fever | 12/97 (12%) | 19/73 (26%) | 0·02 | ||
| Rash or skin lesions | 131/133 (98%) | 88/90 (98%) | 1† | ||
| Composite rash score (range; IQR) | |||||
| Data available, n | 125 | 82 | .. | ||
| Median (range; IQR) | 6 (1–100; 3–14) | 9 (1–165; 6–21) | 45 356§, p<0·0001† | ||
| Anatomical location of lesions | |||||
| Genitals | 67/131 (51%) | 34/90 (37%) | 0·05 | ||
| Arms | 32/127 (25%) | 24/86 (28%) | 0·66 | ||
| Trunk | 31/129 (24%) | 26/86 (30%) | 0·31 | ||
| Perianal | 29/131 (22%) | 31/87 (36%) | 0·03 | ||
| Face | 27/131 (21%) | 24/91 (26%) | 0·32 | ||
| Mouth, lips, or oral mucosa | 22/132 (17%) | 21/89 (24%) | 0·20 | ||
| Palms of hands | 16/133 (12%) | 9/91 (10%) | 0·62 | ||
| Head | 9/133 (7%) | 11/91 (12%) | 0·17 | ||
| Soles of feet | 5/133 (4%) | 4 (4%) | 1† | ||
| Neck | 3/133 (2%) | 4/91 (4%) | 0·45† | ||
| Other¶ | 7/133 (5%) | 7/89 (8%) | 0·43 | ||
| Same stage of lesion development | 65/102 (64%) | 38/76 (50%) | 0·07 | ||
| Same size lesions | 48/96 (50%) | 32/76 (42%) | 0·30 | ||
| Appearance of lesions | |||||
| Well-circumscribed | 68/113 (60%) | 56/84 (67%) | 0·35 | ||
| Umbilicated | 60/113 (53%) | 52/84 (62%) | 0·22 | ||
| Deep seated and profound in the skin | 37/113 (33%) | 31/84 (37%) | 0·54 | ||
| Other‖ | 48/113 (43%) | 28/84 (33%) | 0·19 | ||
| Lymphadenopathy | 80 (62%) | 54/90 (60%) | 0·76 | ||
| Anatomical location | |||||
| Inguinal | 54/77 (70%) | 38/54 (70%) | 0·98 | ||
| Cervical | 28/77 (36%) | 17/54 (32%) | 0·56 | ||
| Submandibular | 6/77 (8%) | 7/54 (13%) | 0·33 | ||
| Axillary | 4/77 (5%) | 1/54 (2%) | 0·65† | ||
| Other** | 2/77 (3%) | 2/54 (4%) | 1† | ||
| Other STI | 16/112 (14%) | 14/81 (17%) | 0·57† | ||
| Treatment | |||||
| Cidofovir | 9/134 (7%) | 5 (5%) | 0·80† | ||
| Tecovirimat | 4/134 (3%) | 6 (7%) | 0·32† | ||
| Vaccinia immune globulin | 0 | 1 (1%) | 0·41† | ||
| Brincidofovir | 0 | 0 | .. | ||
| No known treatment | 120 (90%) | 80 (87%) | 0·55 | ||
| Outcomes | |||||
| Admitted to hospital | 17 (13%) | 13 (14%) | 0·75 | ||
| Reason for hospital admission | |||||
| Severe illness | 10/17 (59%) | 6/13 (46%) | 0·49 | ||
| Need for isolation | 6/17 (35%) | 4/13 (31%) | 0·71† | ||
| Other†† | 1/17 (6%) | 3/13 (2%) | 0·61† | ||
| Outcome at last contact | |||||
| Alive and discharged | 96/103 (93%) | 73/75 (97%) | 0·21 | ||
| Alive and remain in hospital | 7/103 (5%) | 2/75 (2%) | 0·31† | ||
| Deceased | 0 | 0 | .. | ||
STI=sexually transmitted infection.
χ2 p-value, unless stated otherwise.
Fisher's exact test.
Included anal discharge (n=2), anal pain (n=2), arthralgia (n=2), dysphagia (n=2), groin pain (n=2), decreased urine output (n=1), foot dysesthesia (n=1), nasal congestion (n=1), and weight loss (n=1).
Wilcoxon test statistic.
Included pubis (n=3), inguinal (n=3), lower extremities (n=2), hands (n=1), back (n=1), buttocks (n=1), fingers (n=1), forearms (n=1), and unspecified (n=1).
Included descriptions such as papules, vesicles, ulcers, and necrosis.
Included generalised (n=2), preauricular (n=1), and root of penis (n=1).
Included supportive care (n=3) and medical curiosity (n=1).