Clinical characteristics of mpox infection in individuals who received a first dose of modified vaccinia Ankara immunisation.

INTRODUCTION: A key part of the response to the mpox (monkeypox) epidemic has been the vaccination campaign targeted at gay, bisexual and other men who have sex with men (GBM), including people living with HIV (PLWH). METHODS: We undertook a single-site, retrospective analysis of individuals who received a single dose of modified vaccinia Ankara (MVA-BN) prior to the onset of mpox symptoms. Demographics, clinical characteristics and patient management were analysed. RESULTS: Of 10 068 individuals who received a first dose of the MVA-BN vaccination, 15 (0.15%) developed mpox subsequently. All individuals identified were GBM with 12/15 (80%) on Pre-exposure prophylaxis (PrEP) and 3/15 (20%) PLWH. Median time from MVA-BN inoculum to mpox symptoms was 4 days (IQR 3-9), systemic symptoms and supportive medical treatment required were common (11/15 patients, 73%) and all had localising skin lesions. One individual required hospitalisation. CONCLUSIONS: Although clinical presentation was similar to unvaccinated cohorts, we observed low numbers of mpox cases following a first dose of MVA-BN vaccination. Larger, multicentric studies are needed to further evaluate vaccination failure and immunity duration.

COVID-19 restrictions and changing sexual behaviours in HIV-negative MSM at high risk of HIV infection in London, UK.

OBJECTIVES: The COVID-19 pandemic and its related restrictions have affected attendance to and delivery of UK sexual healthcare services (SHS). We surveyed the impact on sexual behaviour of men having sex with men (MSM) to inform future SHS provision. METHODS: We conducted a cross-sectional, anonymous, web-based survey among HIV-negative MSM at high risk of HIV infection who attended 56 Dean Street, a sexual health and HIV clinic. The survey was conducted over a 7-day period in August 2020. Data on sociodemographic characteristics, sexual behaviour and related mental well-being experienced during lockdown (defined as 23 March-30 June 2020) were extracted. Categorical and non-categorical variables were compared according to HIV pre-exposure prophylaxis (PrEP) use. RESULTS: 814 MSM completed the questionnaire: 75% were PrEP users; 76% reported they have been sexually active, of which 76% reported sex outside their household. 75% reported fewer partners than prior to lockdown. Isolation/loneliness (48%) and anxiety/stress (27%) triggered sexual activity, and 73% had discussed COVID-19 transmission risks with their sexual partners. While 46% reported no change to emotions ordinarily experienced following sex, 20% reported guilt for breaching COVID-19 restrictions. 76% implemented one or more changes to their sexual behaviour, while 58% applied one or more steps to reduce COVID-19 transmission during sex. 36% accessed SHS and 30% reported difficulties in accessing testing/treatment. Of those who accessed SHS, 28% reported an STI diagnosis. PrEP users reported higher partner number, engagement in 'chemsex' and use of SHS than non-PrEP users. CONCLUSIONS: COVID-19 restrictions had a considerable impact on sexual behaviour and mental well-being in our survey respondents. High rates of sexual activity and STI diagnoses were reported during lockdown. Changes to SHS provision for MSM must respond to high rates of psychological and STI-related morbidity and the challenges faced by this population in accessing services.

Dolutegravir: an exciting new kid on the block.

INTRODUCTION: Dolutegravir is the first second-generation integrase inhibitor approved for the treatment of naïve as well as experienced HIV-infected individuals. AREAS COVERED: Data from pharmacokinetics, efficacy, safety, tolerability and resistance are reviewed from in vitro studies, Phase II and III clinical trials published in PubMed (Dolutegravir; S/GSK1349572) or presented in international meetings. EXPERT OPINION: Data from studies and clinical trials indicate that dolutegravir is safe, well tolerated and highly efficacious in the treatment of both antiretroviral-naïve and treatment-experienced patients and appears to have a higher genetic barrier to resistance than first-generation integrase inhibitors.