ArticleResearch square2026
MPXV replication and drug resistance in CNS of advanced HIV case at autopsy.
Article in Research square, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Authors and funding
17 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Monkeypox virus (MPXV) clade IIb caused an outbreak of >100,000 cases globally, with highest disease burden in people living with advanced human immunodeficiency virus (HIV), those with CD4 count <200 cells/mm3. We performed an extensive autopsy on a fatal case of mpox in a person living with advanced HIV-1, who achieved HIV suppression but poor immune reconstitution despite > 6 months antiretroviral therapy and had progressive necrotizing mucocutaneous mpox disease despite multiple prolonged mpox-targeted therapies. We quantified MPXV DNA across 76 tissues and observed a high burden in skin and mucosal tissue and a lower burden in all central nervous system (CNS) tissues tested. However, we detected replication-competent MPXV in multiple CNS tissues and confirmed neuronal and glial cell infection using RNA-scope in situ hybridization. MPVX sequencing from body and brain tissues revealed widespread tecovirimat resistance-associated variants. This case proves that replication-competent MPXV and tecovirimat resistance-associated isolates can infect and persist in the CNS of people with advanced HIV thus informing future therapeutic design.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.