Thread by @AbraarKaran

1/ Tpoxx (Tecovirimat) resistance in immunocompromised patients, many of whom received multiple courses of treatment. Reminder- tpoxx is our first-line antiviral against monkeypox/mpox.

Important pre-print from CDC Monkeypox/mpox response team
medrxiv.org/content/10.110…

2/ Having worked on surveillance for a number of cases for the past several months, I think key is that many are patients also w/ tough social challenges which have made adherence to antiretroviral medications difficult, setting them up for a double-hit with AIDS + mpox @g0ingmad

3/ Health equity again is at the core of epidemic response. Over time, it is possible that we see circulation of these #mpox variants even in patients who have not been exposed to tecovirimat yet (more on this soon), esp if we see a resurgence this year. @gregggonsalves

4/ As the #mpox outbreak slowed down, media coverage labeled this as being 'over' but at health departments, we saw ongoing low-level transmission esp among our society's most vulnerable--> patients w/ homelessness, uncontrolled AIDS, psychiatric disease, etc

5/ These are patients who have been severely sick and/or died despite the availability of medications, including antiretrovirals for HIV/AIDS and antivirals (tpoxx,brin) + VIGIV for mpox being available. Our care systems failed them @JoiaMukherjee

nejm.org/doi/full/10.10…

6/ What happens when outbreaks 'end'? Who still suffers? We all do. We are deeply interconnected, esp when talking about transmissible infectious diseases. A virus with resistance to first-line treatments is a serious issue if/when there is wider spread.

cc @PaulSaxMD @CarlosdelRio7 @benjamin_pinsky @JasonAndrewsMD