{"id":46166,"date":"2023-09-01T07:20:51","date_gmt":"2023-09-01T07:20:51","guid":{"rendered":"https:\/\/i-base.info\/htb\/?p=46166"},"modified":"2023-09-14T09:58:02","modified_gmt":"2023-09-14T09:58:02","slug":"tecovirimat-resistance-in-a-person-with-advanced-hiv-and-delayed-art","status":"publish","type":"post","link":"https:\/\/i-base.info\/htb\/46166","title":{"rendered":"Tecovirimat resistance in a person with advanced HIV and delayed ART"},"content":{"rendered":"<p><strong>Simon Collins, HIV i-Base<\/strong><\/p>\n<p><strong>Although tecovirimat is currently being used to treat mpox it has a low genetic barrier to drug resistance. The Annals of Internal Medicine published a very difficult case report of a 53-year-old man diagnosed with advanced HIV and who on autopsy also showed tecovirimat-resistant mpox. <\/strong><\/p>\n<p>He presented in November 2022 with symptoms of advanced HIV infection including weight loss, a longstanding large, painful anal ulcer; and proctitis, but without skin lesions. His CD4 and viral load were 20 cells\/mm<sup>3<\/sup> and 523,000 copies\/mL respectively. He also had chronic HBV, latent syphilis,\u00a0<em>Cryptococcus neoformans<\/em>\u00a0antigenemia, anal\u00a0<em>Chlamydia trachomatis<\/em>\u00a0infection, and suspected CMV colitis.<\/p>\n<p>However, he did not start ART for a further six weeks after worsening anal pain and lesions that were mpox positive. Treatments for HIV (Biktarvy), CMV (IV ganciclovir) and mpox (tecovirimat) were all started.<\/p>\n<p>Tecovirimat was given 600 mg twice-daily and the majority of lesions resolved within two weeks. However, some anal lesions and viral shedding persisted, and further testing was run. Retrospective sequence analysis identified a F13L mutation, present from day 11, which confers tecovirimat resistance.<\/p>\n<p>Although mpox DNA was no longer detectable in blood after day 25, it remained high up to day 48 (Ct, 21.58) and detectable up to the end of follow-up (Ct, 33.94 at day 88).<\/p>\n<p>However, the retrospective analysis also showed protracted mpox shedding for at least 87 days before the use of tecovirimat, when a minor fraction of the resistant variant was already detectable.<\/p>\n<p>This case highlights the rapid development of tecovirimat resistance in the context of multiple clinical complications and advanced HIV, despite recovery of CD4 count to approximately 100 cells\/mm<sup>3<\/sup> by day 48.<\/p>\n<p>Reference:<\/p>\n<p>Mertes H et al. Tecovirimat resistance in an immunocompromised patient with Mpox and prolonged viral shedding. Annals of Internal Medicine. DOI:10.7326\/L23-0131. (25 July 2023).<br \/>\n<a href=\"https:\/\/www.acpjournals.org\/doi\/10.7326\/L23-0131\">https:\/\/www.acpjournals.org\/doi\/10.7326\/L23-0131<\/a><\/p>\n\n","protected":false},"excerpt":{"rendered":"<p>Simon Collins, HIV i-Base Although tecovirimat is currently being used to treat mpox it has a low genetic barrier to drug resistance. The Annals of Internal Medicine published a very difficult case report of a 53-year-old man diagnosed with advanced &hellip;<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[323],"tags":[],"class_list":["post-46166","post","type-post","status-publish","format-standard","hentry","category-mpox"],"_links":{"self":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts\/46166","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/comments?post=46166"}],"version-history":[{"count":4,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts\/46166\/revisions"}],"predecessor-version":[{"id":46311,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts\/46166\/revisions\/46311"}],"wp:attachment":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/media?parent=46166"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/categories?post=46166"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/tags?post=46166"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}