Objectives: Models of mpox outbreaks have not fully accounted for epidemiologic heterogeneity by HIV status and sexual risk behaviors. Therefore, our objectives were to develop an innovative compartmental model that accounts for these heterogeneities and to evaluate the impact of targeted vaccination scenarios in a theoretical outbreak of mpox in Washington, DC. Methods: We developed a Susceptible-Vaccinated-Exposed-Infectious-Recovered (SVEIR) compartmental model with six different risk strata accounting for sexual risk behaviors, HIV status, and CD4. We then evaluated a theoretical 6-month outbreak of mpox in Washington, DC under various targeted vaccination scenarios. From each vaccination scenario, we chose an optimal set of vaccination rates based on the number of mpox cases, severe cases, deaths, and effective reproduction number (Reff). Results: We found that vaccinating 25% of individuals with high sexual risk behaviors was optimal. If vaccination is introduced immediately, this scenario resulted in only 316 mpox cases, no deaths, an Reff of 1.69 at the end of the 6-month period, and only required vaccinating 9,090 individuals. Conclusions: In order to control future mpox outbreaks, vaccination campaigns should target individuals with high sexual risk behaviors and be implemented in tandem with isolation protocols and partner reduction.

Background People of Asian ethnicity represent one of the fastest-growing populations in the United States and may experience unique social and cultural challenges to accessing sexual healthcare. This analysis explores disparities in annual sexually transmitted infection screening and diagnosis rates per person-year between Asian and non-Asian people with human immunodeficiency virus in Washington, District of Columbia (DC). Methods Using District Columbia cohort data, a longitudinal study of people living with human immunodeficiency virus receiving care in Washington, DC, we analyzed people with human immunodeficiency virus aged 18 or older with at least 1 year of follow-up between 2018 and 2023. Logistic regression was used to examine differences in sexually transmitted infection screening and diagnoses between Asian and non-Asian participants, while linear trend analyses were used to assess changes in the number of screenings and diagnoses between Asian and non-Asian participants. Results Among 8679 eligible participants, 0.88% (n = 76) were Asian. No significant differences in total sexually transmitted infection screenings or diagnoses were observed. However, Asian participants had higher screening rates per person-year for pharyngeal and urogenital gonorrhea, pharyngeal chlamydia, and syphilis. Chlamydia incidence was higher among Asian than non-Asian participants. Over 30% of both groups met the annual screening recommendation during the study period. Conclusions Asians had comparable screening rates to non-Asians, but the small sample size limited the generalizability of our findings. Nonetheless, this study helps address an existing gap in the literature on Asian sexual health. Larger studies with detailed ethnic and social data are needed to deepen our understanding of sexual health service use within Asian communities.

OBJECTIVES:High viral load and low CD4+ cell count may be associated with increased risk of mpox acquisition. However, prior studies have not evaluated whether longitudinal trends in HIV lab measures, measured as the slope over time, are associated with mpox acquisition or severe mpox. Therefore, we evaluated whether longitudinal trends in CD4+ cell count (cells/μl), viral load (copies/ml), and copy-years viremia (CYV) (copies × years/ml) were associated with increased risk of mpox acquisition. DESIGN:We conducted a nested case-control study among participants in the DC Cohort, a longitudinal study on people with HIV (PWH) in Washington, DC. METHODS:Cases were defined as participants with mpox and were matched to five controls using risk set-sampling. Both two-stage modeling and joint modeling approaches were used to evaluate whether longitudinal trends in CD4+ cell count, viral load, and CYV were associated with mpox acquisition. RESULTS:We evaluated 53 cases of mpox and 248 matched controls, with 13.7% of cases having severe mpox. An increased slope of CYV was associated with an increased risk of mpox acquisition based on the joint modeling approach, after adjusting for AIDS and known antiretroviral regimen [hazard ratio (95% CI): 1.11 (1.04-1.18)]. CONCLUSION:Clinicians should consider a patient's entire history of viral load, not just viral load measured at one point in time, when evaluating risk of mpox.

Latina/o/x (Latino) populations are disproportionately affected by HIV, with intersecting social and structural factors shaping outcomes. To capture these complex intersections, we applied a decision tree approach, Chi-squared Automatic Interaction Detector (CHAID), to examine engagement in care and viral suppression among adult Latinos enrolled in the DC Cohort, a longitudinal electronic health record–based cohort of people with HIV across 15 Washington, DC, clinics (2011–2019). Socio-structural variables included age, gender identity, HIV risk category, country of birth, mental health diagnosis, substance use, housing, employment, and insurance. Engagement in care was defined as ≥ 2 visits ≥ 90 days apart with laboratory work in the prior year; viral suppression as < 200 copies/mL. Analyses included chi-square tests and CHAID decision trees. Among 541 participants, most were cisgender male (85

BACKGROUND:We examined factors related to being out of care (OOC) or reentering care after clinic transfer among people with HIV in Washington, DC using clinical and linked surveillance data from the DC Department of Health (DC Health). METHODS:Using DC Cohort HIV care encounters and laboratory results, linked surveillance data, and chart review, we determined if participants were (1) engaged in care; (2) OOC; (3) died; (4) withdrew; (5) clinic-reported transfer; (6) surveillance-based transfer (using DC Health data); and (7) undetermined. Of the clinic-reported transfers, we used surveillance data to determine whether participants reentered care after transfer. We evaluated associations between participant characteristics, being OOC, and reentering care using logistic regression. RESULTS:We evaluated 12,563 DC Cohort participants, 6557 (52.5%) were engaged in care, 748 (6.0%) OOC, 1893 (15.0%) clinic-reported transfers, 1692 (13.5%) surveillance-based transfers, 1418 (11.0%) died, 41 (0.3%) withdrew, and 214 (1.7%) were undetermined. Of clinic-reported transfers, 832 (44.0%) reentered care, with 80.9% achieving viral suppression (<200 copies/mL). In the adjusted analysis, females, older age, non-Hispanic Black race, longer time since HIV diagnosis, CD4 ≥ 500 cells/µL, former or never smoking, and public insurance were associated with being engaged in care. Similarly, non-Hispanic Black race, non-Hispanic White race, nonviral suppression, Ryan White clinic, former alcohol abuse, and temporary/unstable housing were associated with reentering care among the clinic-reported transfers, after adjusting for covariates. CONCLUSIONS:Individual, clinical, and structural factors were associated with being OOC or care reentry. Targeted interventions addressing these factors may improve sustained HIV care and reduce transmission.

Background: The validated Screening Tool of Older People’s Prescriptions (STOPP) identifies potentially inappropriate prescribing (PIP)—treatments where potential risk outweighs potential benefit. STOPP is particularly important for people aging with HIV and comorbidities, since PIP may exacerbate symptoms and decrease adherence. Methods: We analyzed data from the DC Cohort, a longitudinal cohort of people with HIV (PWH). We applied STOPP criteria to identify PIP among DC Cohort participants aged ≥ 50 years who completed a Patient Reported Outcomes (PROs) survey. All medications prescribed in the 2 years prior to PROs survey completion were considered. Negative binomial models were used to evaluate factors associated with PIP and structural equation modeling was used to evaluate whether symptom burden mediates the relationship between PIP and quality of life. Results: Of 1048 eligible DC Cohort participants, 486 (46%) had at least one PIP. The most common systems implicated were musculoskeletal (23%), analgesic drugs (16%), and the central nervous system (13%). Age, race/ethnicity, HIV transmission factor, social determinants of health, and type of HIV care site were significantly associated with number of PIP in the crude models. In the multivariable model with just demographic variables, the association between age (aIRR: 1.03 (95% CI: 1.02, 1.04)), intravenous drug use (aIRR: 1.68 (95% CI: 1.20, 2.35)), White, non-Hispanic race (aIRR: 0.67 (95% CI: 0.50, 0.92)), site type (aIRR: 0.75 (95% CI: 0.62, 0.92)), and the expected number of PIPs remained significant. In the fully adjusted multivariable model with demographics and SDOH, the association between age, intravenous drug use, White, non-Hispanic race, and expected number of PIPs remained significant. Statistical evidence that symptom burden mediates the relationship between PIP and each of the QOL dimensions was present. Conclusions: Future interventions should work to decrease PIP among these high-risk groups, especially for PIP associated with increased symptom burden.

OBJECTIVE:To evaluate the impact of advancing age, comorbidity burden, and the COVID-19 pandemic on HIV clinic visit attendance. STUDY SETTING AND DESIGN:We implemented a repeated cross-sectional study using an ongoing longitudinal cohort of people with HIV (PWH) receiving care in Washington, DC. DATA SOURCES AND ANALYTIC SAMPLE:Our primary exposures of interest were older age categories (60-69 and 70+ compared with 50-59 years), Veterans Aging Cohort Study (VACS) Index (surrogate for comorbidity burden), calendar year (with the three time points of 2018, 2020, and 2022 representing pre-, peri- and post-COVID). Our outcome was the number of HIV clinic visits (including telehealth) in 2018, 2020, and 2022. Associations were assessed using zero-inflated negative binomial modeling. PRINCIPAL FINDINGS:4041 (72.7% men, 59.3% ages 50-59; 78.8% Black) DC Cohort participants aged 50+ years were included. In 2018, mean VACS indices for participants aged 50-59, 60-69, and 70+ years were 27.5 (standard deviation [SD] 15.8), 36.9 (SD 17.8), and 50.7 (SD 15.5) respectively. Increase in VACS Index was associated with increase in HIV clinic visits (Rate ratio: 1.03, 95% CI 1.01, 1.05). A VACS Index-calendar year interaction term was significant, indicating the relationship between VACS Index and visits was attenuated in the post-COVID time period. All age groups experienced a decrease in visits from 2018 to 2022. HIV RNA suppression remained stable. CONCLUSIONS:These findings underscore the pandemic's impact on accessing healthcare among the most vulnerable, that is, the oldest participants with the most comorbidities. Developing differential care models for PWH to target services to their local context, clinical status, and preferences may point to a broader public health approach to mitigate post-pandemic changes in HIV care utilization.

BACKGROUND:Dermatologic disease (DD) remains a significant morbidity among people with human immunodeficiency virus (HIV) (PWH), yet epidemiologic data in the modern antiretroviral therapy (ART) era are limited. OBJECTIVE:To characterize the prevalence, incidence, and risk factors of DD among PWH. METHODS:This longitudinal cohort study included 11,738 adults enrolled in the DC Cohort between 2011 and 2023. DDs were identified using ICD-9/10 codes and categorized as infectious dermatoses, inflammatory dermatoses, or cutaneous malignancies (CM). Prevalence, incidence trends, and multivariable logistic regression were used to identify risk factors. RESULTS:Among participants, 49.4% had ≥1 dermatologic diagnosis, with infectious conditions most common (41.4%). Incidence declined from 2011 to 2024 across all categories: infectious (463 to 41), inflammatory (306 to 62), and malignant (31 to 6) cases per 1000 (all P < .0001). Cisgender females had over sixfold greater odds of CM. Lower nadir CD4 count, older age, public insurance, and prior opportunistic infections were associated with higher DD risk. LIMITATIONS:Use of ICD codes may have introduced misclassification; dermatology specialty access likely varied by site. CONCLUSION:DD incidence has declined over time, reflecting advances in HIV care and treatment. Despite modern ART, DD remains prevalent. Demographic, immune, structural, and behavioral factors drive risk among PWH, underscoring the need for targeted care.

Abstract Background Despite the availability and efficacy of two-drug regimens (2DR) for HIV treatment, three-drug regimens (3DR) are mostly used by people with HIV (PWH). We evaluated virologic outcomes of initiating or switching to a 2DR vs 3DR among PWH in Washington, DC. Adjusted Cox Proportional Hazard Regression Model for Virologic Non-Suppression (viral load > 200 copies/mL) among PWH by Two- and Three-Drug Regimens in the DC Cohort, 2019-2023 Methods We included DC Cohort treatment-experienced participants initiating or switching to a 2DR or 3DR on or after July 2019 with ≥2 years of follow-up. Descriptive statistics for demographic and clinical factors at regimen initiation, including HIV viral load (VL) and CD4 count (cells/µL), were stratified by 2DR or 3DR. Multivariable Cox proportional hazard modeling was performed among participants virally suppressed (VS; VL< 200 copies/mL) at regimen initiation to assess the time to non-virologic suppression (non-VS) using adjusted hazard ratios (aHR) and 95% CI adjusting for demographics, HIV risk, and regimen. Among participants who were not VS at the time of regimen initiation, we conducted a sub-analysis of the time to VS. Results We analyzed 1782 participants (72.8% 3DR, 28.2% 2DR (161 switched from a 3DR); age 54.3 years (IQR 43.8-61.3), 68.8% male; 78.1% Black) with a median CD4 621 (IQR 409-868) at regimen initiation. Participants on 2DR were older (56.4 vs 53.6 years; p< 0.001) and had higher VS rates (93.8% vs 88.2%; p< 0.001) at regimen initiation and shorter regimen times (3.2 vs 3.8 years; p< 0.001) compared to 3DR. 2DR participants were more likely to have public vs private insurance and receive hospital vs community-based care. The risk of non-VS was higher among those with CD4 < 200 and 200-500 (aHR 1.5(1.0-2.1) and aHR 2.0(1.1-3.6), respectively) compared to those with CD4 >500. Those with public insurance were also more likely to experience non-VS (aHR 1.5; p< 0.05). While regimen type was not a significant predictor of non-VS, there was an elevated risk among those on 3DR (aHR 1.2) compared to 2DR [Figure]. Among those non-VS at regimen initiation (n=146), the median time to VS was similar among PWH on 2DR (14.1 months) and 3DR (13.8 months; p=0.76). Conclusion Non-VS PWH have similar time to VS regardless of whether they receive 2DR or 3DR, suggesting similar efficacy of 2DR and 3DR in these populations. Patients with CD4 < 500 had higher risk of non-VS on 2DR, supporting the usefulness of the CD4 criteria factor when selecting 2DR vs 3DR. Disclosures All Authors: No reported disclosures

Long-acting injectable (LAI) cabotegravir/rilpivirine (CAB/RPV) provides an effective treatment option for people with HIV (PWH). Studies suggest that PWH on LAI CAB/RPV may experience isolated episodes of transient viremia (HIV RNA > 20 copies/mL) defined as virologic blips (VB). The risk factors for VB in PWH receiving LAI CAB/RPV are limited. We aimed to describe a cohort of PWH on LAI CAB/RPV and evaluate risk factors and time to VB following LAI CAB/RPV initiation. We obtained DC Cohort data from PWH who initiated LAI CAB/RPV prior to July 2023 and used Kaplan-Meier curves and Cox proportional hazards models to evaluate the association between participant demographics, HIV clinical factors, and time to VB. Among 98 PWH who initiated LAI CAB/RPV, 9 (9.2%) experienced at least one VB (median HIV RNA = 50 copies/mL; ranges 30-12,000 copies/mL) during a median follow-up period of five months (IQR: 2-10). The median CD4 count among PWH was 754 cells/µL (IQR: 598, 980) at the time of LAI CAB/RPV initiation. Having a high CD4 (≥ 500 cells/μL) at LAI CAB/RPV initiation was significantly associated with a lower hazard for VB when compared to baseline CD4 < 200 cells/µL [hazard ratios (HR): 0.15 [95% confidence intervals (CI): 0.03, 0.77]; aHR: 0.07 (95% CI: 0.01, 0.50); log-rank p = .026]. No other characteristics were significantly associated with time to VB, and no participants experienced virologic failure. Considerations for baseline CD4 may be important when initiating a patient on LAI CAB/RPV, and future studies will help evaluate the VB occurrence and associated factors among PWH.

Aim:Patient reported outcomes (PROs) can help to evaluate gaps and areas for improvement along the HIV care continuum. We sought to describe the methodology and processes of a PROs study within the DC Cohort study population, describe the PROs results to date, report on lessons learned, and describe future directions of the research. Subject and Methods:Each study site recruited participants from the DC Cohort, a longitudinal study on people with HIV, to complete the electronic PROs baseline and annual follow-up surveys, which consisted of previously validated measures of social determinants of health, mental health, substance use, medication adherence, and other related measures. The recruitment, enrollment, and data linkage process strengths and limitations were described. Participants' PROs survey responses were linked to their DC Cohort data to better understand participant's health overall. Results:There have been 1,739 baseline, 610 first annual, and 142 second annual completed surveys between May 2021 and May 2024. Among PROs participants, the most common reported unmet need was food insecurity (33.5%) and the most common mental health condition was generalized anxiety disorder (39.5%). A majority (59.7%) of participants reported being sexually active, but at least half did not use barrier protection. Conclusion:PROs surveys complement electronic health record data collected in the DC Cohort study, allowing for examination of health outcomes and factors collected in a longitudinal manner. PROs results could be integrated into near-real time dashboards for use by clinicians and incorporated into routine clinical care to provide a more holistic understanding of the patient.

BACKGROUND:Women with HIV are at an elevated risk for HPV. Antiretroviral therapy (ART) effectively treats HIV; however, there is no noninvasive pharmacologic treatment for HPV. Previous studies have shown varied effects of ART class on HPV clearance, with some demonstrating an association. Our objective was to evaluate the association between ART class and HPV clearance among women with HIV/HPV coinfections. METHODS:We analyzed electronic health records from participants with HPV in the DC Cohort Longitudinal HIV Study from time at HPV detection to January 1, 2024. We investigated time to HPV clearance based on time-updated ART status using Cox proportional hazards and Kaplan-Meier models, focusing on protease inhibitors (PIs) and integrase strand transfer inhibitors. RESULTS:Among 362 women with HIV/HPV coinfections, 94.8% were non-Hispanic Black, 81.2% had public insurance, and 45.6% were smokers. Overall, 74.0% cleared their HPV infection. A higher proportion of participants who cleared HPV were on PIs at baseline compared with those who did not ( P = 0.03). Those who did not achieve clearance had lower nadir CD4 counts ( P = 0.04) and did not achieve viral suppression ( P = 0.0005). In the survival analysis, women on PI-based regimens had shorter time to HPV clearance than those on integrase strand transfer inhibitors (HR = 2.12, 95% CI: 1.39 to 3.24). CONCLUSIONS:This study suggests that PIs may be associated with a higher likelihood of HPV clearance among women with HIV. Our results provide evidence on the influence of clinical and sociodemographic factors, including ART, that may affect HPV clearance among women with HIV.Key words: HIV/HPV co-infection, antiretrovial therapy, HPV clearance.

People with HIV (PWH) with substance use disorders (SUD) have worse health outcomes than PWH without SUD. Our objective was to characterize substance use patterns and their impact on longitudinal HIV RNA trajectories among those enrolled in an observational study of PWH in care in Washington, DC. Substance use by type (alcohol, cannabis, opioid, stimulant, hallucinogen, inhalant, sedative) was used to identify shared patterns of substance use using Latent Class Analysis (LCA). A multinomial logistic regression model evaluated the association between the resulting substance use classes and the membership probability in longitudinal HIV RNA trajectory groups. There were 30.1

INTRODUCTION The prevalence and control of HTN among people with HIV (PWH) have not been widely studied since the release of newer 2017 ACC/AHA guidelines ("new guidelines"). Hence, we evaluated the prevalence and control of HTN using both 2003 JNC 7 ("old guidelines") and new guidelines. METHODS We identified 3206 PWH with HTN from the DC Cohort study in Washington, D.C, between 01/2018 and 06/2019. We defined HTN using International Classification of Diseases (ICD) -9/-10 diagnosis codes for HTN or ≥2 BP measurements obtained at least one month apart (>139/89 mm Hg per old or >129/79 mm Hg per new guidelines). We defined HTN control based on recent BP (≤129/≤79 mm Hg per new guidelines). We identified socio-demographics, cardiovascular risk factors and co-morbidities associated with HTN control using multivariable logistic regression (adjusted Odds Ratio; 95% CI). RESULTS The prevalence of HTN was 50.9 % per old versus 62.2% per new guidelines. Of the 3,206 PWH with HTN 887 (27.7%) had a recent BP ≤129/≤79 mm Hg, 1,196 (37.3%) had a BP 130-139/80-89 mm Hg and 1,123 (35.0%) had a BP ≥140/≥90mm Hg. After adjusting for socio-demographics, cardiovascular risk factors and co-morbidities, factors associated with HTN control included age 60-69 (vs. <40) years (aOR 1.42; 95 % CI 1.03-1.98), Hispanic (vs. non-Hispanic Black) race/ethnicity (aOR 1.49; 95 % CI 1.04-2.15), receipt of HIV care at a hospital-based (vs. community-based) clinic (aOR 1.21; 95 % CI 1.00-1.47), being unemployed (aOR 1.42; 95% CI 1.11-1.83), and diabetes (aOR 1.35; 95% CI 1.13-1.63). CONCLUSION In a large urban cohort of PWH, nearly two-thirds had HTN and less than one-third of those met new guideline criteria. Our data suggests that more aggressive HTN control is warranted among PWH, with additional attention to younger patients and non-Hispanic Black patients.

Post-COVID conditions (long COVID) are defined as COVID symptoms persisting 28 days post-initial infection. The limited research available on the prevalence and experiences of post-COVID conditions among persons with HIV (PWH) indicates potential increased risk for post-COVID conditions. The purpose of this study was to characterize prevalence, symptom clustering, impact, and potential risk factors of post-COVID conditions among PWH. Data come from the COVID-19 survey, conducted as a sub-study of the DC Cohort Longitudinal HIV Study, an ongoing study of over 12,000 PWH living in Washington, DC. Survey data were matched to electronic medical record data. Prevalence estimates and multivariable logistic regression analyses were calculated comparing those with and without post-COVID conditions. The prevalence of post-COVID conditions among PWH was 46% with no significant differences among demographic or HIV measures. Those with history of asthma were more likely to report post-COVID conditions symptoms. Among those with post-COVID conditions, 81% reported three or more initial COVID symptoms. Retired/disabled PWH were more likely to report post-COVID conditions compared to employed (aOR = 2.37, 95% CI = 1.06, 5.33). Post-COVID conditions significantly limited activities of daily living. Programs are needed to address the long-term impact of post-COVID conditions on activities of daily living among PWH.

When an initial antiretroviral therapy (ART) regimen is effective and well-tolerated, it can be maintained for years as long as the patient adheres. Prior research has revealed that shorter initial ART duration is associated with regimen type, female sex, injection drug use as the HIV transmission category, and lower baseline CD4 count. We examined potential factors associated with initial regimen discontinuation among a subset of newly diagnosed virally unsuppressed PWH in the DC Cohort, an ongoing prospective observation study that uses electronic health record data from clinic sites to collect relevant information, including demographic and clinical information. Participants were excluded from the analysis if they had less than 6 months of follow-up and were virally suppressed at enrollment. There were 479 individuals included in the study. The median age of participants was 33.9 years [interquartile range (IQR) 26-43.9]. The sample was predominantly male (79.1%) and of Black race (70.8%). Over half of the study participants (56.4%) attended community-based clinic sites. The median time to the discontinuation of initial ART was 2.7 years [95% confidence interval (CI): 2.3, 3.4]. Females had a shorter time to ART discontinuation [adjusted hazard ratio (aHR) 1.55, 95% CI: 1.14, 2.11] as did individuals who started on a protease inhibitor-based regimen versus integrase strand transfer inhibitors (aHR 1.87, 95% CI: 1.34, 2.61) and those receiving HIV care at a community-based site (aHR 1.46, 95% CI: 1.11,1.93). Although limited by lack of reason for discontinuation, we demonstrated that ART-naïve women, community clinic attendees, and patients starting on PIs had a shorter duration of initial ART. More anticipatory guidance may be needed to help patients stay on their initial therapy and manage the side effects or to be flexible in trying different regimens.

BACKGROUND:Studies on the incidence of COVID-19 among persons with HIV (PWHs) present varied results. Few studies have investigated the impact of COVID-19 infection on health and socioeconomic factors or COVID-19 stigma. We sought to measure the incidence and severity of COVID-19 infection among a cohort of PWHs, characterize associated risk factors and impact, and document perceptions of COVID-19-related stigma. METHODS:Data for this cross-sectional study come from the COVID-19 survey of participants in the DC Cohort longitudinal study from October 30, 2020, through December 31, 2022. Survey results were linked to electronic health records, including HIV laboratory test results and COVID test results. We conducted analyses comparing demographic, socioeconomic, HIV measures, and stigma among those with and without self-reported COVID-19. RESULTS:Of 1972 survey respondents, 17% self-reported COVID-19 infection, with the greatest incidence in the Omicron wave of the pandemic. We found statistically significant differences by age, employment status, essential worker status, education, and household income. Longer duration of HIV diagnosis was associated with greater incidence of COVID-19. PWHs who were overweight or obese had a greater incidence of COVID-19 compared with those who were not. Over 40% of PWHs with COVID-19 reported experiencing at least 1 form of COVID-19-related stigma. CONCLUSION:We observed a high incidence of COVID-19 infection among PWHs in DC. Furthermore, a substantial proportion of PWHs with COVID-19 reported experiencing COVID-19-related stigma. These findings add to the existing literature on COVID-19 coinfection among PWHs and highlight the need for awareness and support for those experiencing COVID-19 stigma.

People with HIV (PWH) are disproportionally affected by mpox and at risk of severe complications. We assessed mpox knowledge, adoption of preventive behaviors, and vaccination attitudes among PWH enrolled in a longitudinal HIV cohort in Washington, DC, the DC Cohort. We conducted uni- and multivariable analyses comparing participants by vaccination status and HIV risk group, and multinomial regression to identify factors associated with vaccine acceptance. Among 430 PWH, 378 (87.9%) were aware of mpox. Among 373 participants with vaccination status data, 101 (27.1%) were vaccinated, 129 (34.6%) planned to vaccinate, and 143 (38.3%) did not plan to vaccinate. The three vaccination groups differed significantly by age, race, education, HIV risk group, recent STI status, and level of mpox worry (all p < 0.05). A higher proportion of men who have sex with men (MSM) reported limiting their number of sexual partners compared to non-MSM (p < 0.0001). Multinomial regression models comparing vaccinated to unvaccinated PWH found age, education, mode of HIV transmission/gender, and survey period were significantly associated with vaccination status (all p < 0.05). High levels of mpox awareness were observed among this cohort of PWH with more MSM employing risk reduction behaviors and being vaccinated. Ensuring that PWH, regardless of gender, sexual orientation, or age, understand the risks of mpox may improve vaccination uptake.

The high proportion of people with HIV (PWH) in the 2022–2023 mpox outbreak has raised questions surrounding the association between HIV and mpox. The objectives of this study were to evaluate the association between engagement in HIV-associated healthcare and mpox diagnosis, as well as to characterize cases of mpox among PWH. The DC Cohort is a longitudinal cohort of PWH in Washington, DC. We conducted a 5:1 (controls:cases) nested case-cohort study on male participants, matching age and care site. Cases were participants with an identified mpox diagnosis. Conditional logistic regression was used to assess the impact of indicators of engagement in HIV-associated healthcare on mpox diagnosis. We identified 70 cases of mpox in DC Cohort participants randomly matched to 323 controls, for a total of 393 participants included in the analysis. Study participants were primarily non-Hispanic Black (72.3%) with a median age of 41 (IQR: 36, 50). There was no association between engagement in care and mpox diagnosis; however, low CD4 was associated with increased odds of mpox diagnosis (aOR: 4.60 (95% CI: 1.23, 17.11)). Among a cohort of PWH, engagement in care was not associated with mpox diagnosis, suggesting that the overrepresentation of PWH among mpox cases is not due to surveillance bias.