Christian Hoffmann1,2, Heiko Jessen3, Christoph Wyen4,5, Stephan Grunwald6, Sebastian Noe7, Jörn Teichmann3, Anja-Sophie Krauss8, Henning Kolarikal9, Stefan Scholten10, Christoph Schuler11, Markus Bickel12, Clemens Roll13, Peter Kreckel14, Siegfried Köppe14, Matthias Straub15, Gerd Klausen16, Johannes Lenz11, Stefan Esser17, Björn Jensen18, Michael Rausch19, Stefan Unger20, Ramona Pauli21, Georg Härter22, Matthias Müller23, Anja Masuhr24, Guido Schäfer1, Ulrich Seybold25, Sven Schellberg26, Jochen Schneider27, Malte Benedikt Monin28, Eva Wolf29, Christoph D Spinner27, Christoph Boesecke28. 1. Infektionsmedizinisches Centrum Hamburg, Hamburg, Germany. 2. University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Germany. 3. Praxis Jessen2 + Kollegen, Dres. Heiko Jessen und Arne Jessen, Berlin, Germany. 4. Praxis am Ebertplatz Cologne, Köln, Germany. 5. Department I Internal Medicine, University Hospital Cologne, Cologne, Germany. 6. Zentrum für Infektiologie Berlin/Prenzlauer Berg, Berlin, Germany. 7. MVZ Munich am Goetheplatz, Munich, Germany. 8. Infektiologikum Seestrasse, Berlin, Germany. 9. Praxis an der Kulturbrauerei, Berlin, Germany. 10. Dr. Scholten & Schneeweiß GbR, Cologne, Germany. 11. Praxis Turmstrasse, Berlin, Germany. 12. Infektio Research GmbH & Ko KG, Frankfurt, Germany. 13. Praxis Schwabstraße 26, Stuttgart, Germany. 14. Internistische Gemeinschaftspraxis m-50.de, Berlin, Germany. 15. Praxis Prenzlauer Berg, Berlin, Germany. 16. Schwerpunktpraxis für Infektionsmedizin am Oranienburger Tor, Berlin, Germany. 17. Department of Dermatology and Venerology, University of Essen, Essen, Germany. 18. Department of Gastroenterology, Hepatology and Infectious Diseases, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany. 19. Praxis Schoeneberg, Berlin, Germany. 20. Institute for Interdisciplinary Medicine (ifi), Hamburg, Germany. 21. MVZ am Isartor, Munich, Germany. 22. MVZ Medicover Ulm, Ulm, Germany. 23. Praxis für Infektionsmedizin, Freiburg, Germany. 24. Auguste Viktoria-Klinikum, Berlin, Germany. 25. Ludwig-Maximilians-University of Munich, Munich, Germany. 26. NOVO Praxis Berlin, Berlin, Germany. 27. Technical University of Munich, Munich, Germany. 28. Department of Medicine I, Bonn University Hospital, Bonn, Germany. 29. MUC Research GmbH, Munich, Germany.
Abstract
BACKGROUND: Since May 2022, increasing numbers of monkeypox virus (MPXV) infections have been reported from across Europe and North America. Studies, mainly from Africa, have suggested a higher risk for severe MPXV cases in people living with HIV. METHODS: This was a retrospective study of all confirmed MPXV infections observed in the participating centres since 19 May 2022. We conducted a chart review to evaluate clinical characteristics, comorbidities, and coinfections, including HIV, viral hepatitis, and sexually transmitted infections (STIs). RESULTS: By 30 June 2022, a total of 546 MPXV infections were reported from 42 German centres. All patients were men who have sex with men (MSM), of whom 256 (46.9%) were living with HIV, mostly with a preserved immune system and with viral suppression. In total, 232 (42.5%) MSM were also taking HIV pre-exposure prophylaxis (PrEP) and 58 (10.6%) MSM had no known HIV infection or PrEP use. The median age was 39 years (range 20-67), and comorbidities were rare. However, 52.4% and 29.4% of all patients had been diagnosed with at least one STI within the last 6 months or within the last 4 weeks, respectively. The most frequent localizations of MPXV infection were genital (49.9%) and anal (47.9%), whereas fever (53.2%) and lymphadenopathy (42.6%) were the most frequent general symptoms. The hospitalization rate was low (4.0%), and no fatal course was observed. The clinical picture showed no apparent differences between MSM with or without HIV. CONCLUSIONS: In this preliminary cohort analysis from a current large outbreak among MSM in Germany, the clinical picture of MPXV infection did not differ between MSM with and without HIV infection. Severe courses were rare and hospitalization rates were low. However, most patients were relatively healthy, and only a few people living with HIV were viremic or severely immunosuppressed.
BACKGROUND: Since May 2022, increasing numbers of monkeypox virus (MPXV) infections have been reported from across Europe and North America. Studies, mainly from Africa, have suggested a higher risk for severe MPXV cases in people living with HIV. METHODS: This was a retrospective study of all confirmed MPXV infections observed in the participating centres since 19 May 2022. We conducted a chart review to evaluate clinical characteristics, comorbidities, and coinfections, including HIV, viral hepatitis, and sexually transmitted infections (STIs). RESULTS: By 30 June 2022, a total of 546 MPXV infections were reported from 42 German centres. All patients were men who have sex with men (MSM), of whom 256 (46.9%) were living with HIV, mostly with a preserved immune system and with viral suppression. In total, 232 (42.5%) MSM were also taking HIV pre-exposure prophylaxis (PrEP) and 58 (10.6%) MSM had no known HIV infection or PrEP use. The median age was 39 years (range 20-67), and comorbidities were rare. However, 52.4% and 29.4% of all patients had been diagnosed with at least one STI within the last 6 months or within the last 4 weeks, respectively. The most frequent localizations of MPXV infection were genital (49.9%) and anal (47.9%), whereas fever (53.2%) and lymphadenopathy (42.6%) were the most frequent general symptoms. The hospitalization rate was low (4.0%), and no fatal course was observed. The clinical picture showed no apparent differences between MSM with or without HIV. CONCLUSIONS: In this preliminary cohort analysis from a current large outbreak among MSM in Germany, the clinical picture of MPXV infection did not differ between MSM with and without HIV infection. Severe courses were rare and hospitalization rates were low. However, most patients were relatively healthy, and only a few people living with HIV were viremic or severely immunosuppressed.