An international survey, with the participation of the Evandro Chagas National Institute of Infectology (INI), of the Oswaldo Cruz Foundation (Fiocruz), indicated the need to evaluate the inclusion of severe forms of monkeypox as a new condition that defines Aids in disease classifications. of HIV at the US Centers for Disease Control and Prevention (CDC) and at the World Health Organization (WHO). The work was carried out by researchers from 19 countries, including the United States, Spain, Mexico, the United Kingdom and Brazil. They gathered data from confirmed cases of monkeypox (Mpox, also called monkeypox) between May 11, 2022 and January 18, 2023, for a study that evaluated cases in people with advanced HIV infection . The INI/Fiocruz, which is the reference for treating cases of Mpox in Rio de Janeiro, develops research that contributes to fighting this disease. The study also highlighted the fatal outcome of patients with suspected clinical deterioration due to immune reconstitution syndrome (Iris), an inflammatory condition that can occur after initiation of antiretroviral therapy. Of the total of 85 patients who started or restarted the use of antiretrovirals, 25% suspected that the clinical deterioration might have occurred as a result of Iris, and 57% of these died, which brought great concern to the researchers. In terms of prevention, research has indicated that people with HIV and at high risk of monkeypox infection should be prioritized for a preventative vaccine. The work highlighted that two thirds of the registered deaths occurred in Latin America. According to the researchers, the findings are particularly pertinent for countries with low levels of HIV diagnosis or without free universal access to antiretroviral therapy or intensive care units, where the interaction of uncontrolled HIV infection and monkeypox is more prevalent. They also stressed that, in these countries, a concerted effort should be made to provide urgent access to monkeypox antivirals and vaccines. Publication The international work was presented at the 30th Conference on Retroviruses and Opportunistic Infections (Croi 2023 – Conference on Retroviruses and Opportunistic Infections, in free translation), which took place in February in Seattle, in the United States, and was published in the scientific journal The Lancet. The study Mpox in people with advanced HIV infection: a global case series (Mpox in people with advanced HIV infection: a series of global cases, in free translation) analyzed 382 cases, 349 of which, equivalent to 91%, in individuals who were living with HIV. The survey found that 107 patients (28%) were hospitalized and 27 died (25%). The deaths occurred in people who had advanced immunodepression due to HIV. The work highlighted the description of a severe form of monkeypox, characterized by necrotizing cutaneous and mucosal lesions, with a high prevalence of fulminant dermatological and systemic manifestations and death, in patients with advanced HIV disease, characterized by TCD4+ lymphocyte counts below 200 cells /mm3. The study had the collaboration of the infectologist from the Laboratory of Clinical Research in STIs and AIDS of the INI/Fiocruz Mayara Secco Torres Silva. Prevention In addition to assisting patients with monkeypox, INI/Fiocruz carries out research to combat the disease. Among them, two multicentric studies under the coordination of the Institute stand out, which should start next March. The first evaluates the MVA-BN Jynneos vaccine, produced by the Bavarian Nordic company, as post-exposure prophylaxis. The vaccine is given after the person has had contact with a high degree of potential exposure to the virus, through intimate contact with a person who is a confirmed case of monkeypox or who has had an accident when handling material contaminated by the virus, both in the collection of clinical material as in the processing of material in the laboratory. The study coordinator and director of INI/Fiocruz, Valdiléa Veloso, told Agência Fiocruz de Notícias that these people should attend the research centers, where they will receive two doses of the vaccine, with an interval of 28 days between doses, if the exposure has occurred within a period of up to 14 days. People whose exposure has occurred after 14 days will be able to participate in the study and will be followed up, but will not be vaccinated. The study provides for the participation of at least 746 people. The expectation, according to the director, is that this immunizer, applied within the expected time interval, can block the process of infection by the virus or attenuate the development of the disease. The second study is called Unity. This is an international clinical trial that will evaluate the safety and efficacy of the antiviral Tecovirimat in the treatment of patients with monkeypox. The study is coordinated by researcher Beatriz Grinsztejn, head of the Laboratory of Clinical Research on STIs and AIDS at INI/Fiocruz, in partnership with Alexandra Calmy, from the University Hospital of Geneva-Switzerland and the French Agency for Research on AIDS, Viral Hepatitis and Emerging Diseases (ANRS). Tecovirimat was developed to treat smallpox and was licensed by the European Medicines Agency (EMA) for monkeypox last year, based on data from limited animal and human studies. So far, however, there have been no clinical trials to confirm whether the drug can help monkeypox patients recover from the disease. The INI/Fiocruz researchers consider that the results of the Unity clinical trial will be of vital importance for clarification in this regard.
Agência Brasil
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