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A recent study published in JAMA Internal Medicine highlights the potential of antiviral tecovirimat (Tpoxx) in slowing down mpox disease progression among individuals living with HIV (PWH) when administered within seven days of symptom onset.
The cohort study, based on outcomes observed in 112 PWH diagnosed with mpox between June 1 and October 7, 2022, revealed significant results regarding the administration timeline of tecovirimat.
Divided into two groups, 56 individuals received tecovirimat within the initial seven days of mpox symptom onset (referred to as the early tecovirimat group), while 56 were either treated later or did not receive tecovirimat at all (referred to as the late or no tecovirimat group).
Notably, the majority of participants in both groups were cisgender men, with over 80% identifying as Black, and an average age of 35 among those in the early tecovirimat group and 36 among the late or no tecovirimat group.
The primary focus of the study was disease progression after seven days, showing that mpox disease progression occurred in only 5.4% of PWH in the early tecovirimat group compared to 26.8% in the late or no tecovirimat group.
Bruce Aldred from Emory University’s School of Medicine in Georgia, a contributor to the study, emphasized the study’s findings, suggesting the immediate commencement of tecovirimat for all PWH upon suspicion of an mpox diagnosis.
However, experts from the universities of Columbia, North Carolina, and Cornell cautioned against a generalized recommendation for Tpoxx administration to all PWH suspected of mpox due to the limitations in tecovirimat availability and current CDC guidelines.
While acknowledging the efficacy demonstrated in the study, these experts pointed out that the majority of PWH in the US might not qualify for Tpoxx use according to current guidelines, particularly those with undetectable viral loads.
Further research is deemed necessary to validate these findings, stressing the need for careful consideration of the limitations and regulatory guidelines before implementing such widespread recommendations.
The study offers promising insights into the potential benefits of early tecovirimat use in managing mpox among PWH, emphasizing the necessity for further investigation and cautious application in line with existing guidelines.
