Mpox Can Infect And Replicate In The Brain, NIH Researchers Say In Fatal HIV Case

A man with advanced HIV died with drug-resistant mpox replicating in his brain, US scientists found, in a case that shows how the virus can persist and evolve just as global health programs to check such infections are being scaled back. The findings, based on a detailed autopsy by researchers at the National Institutes of Health and released as a preprint Thursday, suggest mpox can spread far beyond the skin lesions that typically define the disease. The virus was found infecting the brain and continuing to multiply there despite lower viral levels than in other tissues.

The case also showed mutations linked to resistance to tecovirimat, a drug used against mpox that studies later found offers little benefit for many patients.

The report highlights risks that could increase in parts of Africa, where mpox is spreading among populations with high rates of untreated HIV. Researchers warned in September that cuts to global health funding are undermining HIV care and outbreak response, creating conditions for longer infections and more severe disease.

Since 2022, the clade IIb strain has driven a global outbreak, while separate outbreaks linked to distinct clade I variants have continued in parts of Africa. The World Health Organization says multiple strains are now circulating at once, with cases increasingly concentrated on the continent.

Read More: WHO Confirms 2 Cases Of New Mpox Virus Strain In India And UK, Urges Continued Surveillance

The US patient, a 38-year-old man infected with clade IIb, endured more than seven months of worsening disease despite repeated antiviral therapy. By the time of his death in mid-2023, the virus had entrenched itself throughout his body and remained capable of infecting cells in the brain.

While the findings come from a single patient, the researchers said they show the virus can persist and replicate in the brain and develop resistance-associated mutations.

"Enhanced detection and control efforts, and effective therapeutic development are urgently needed to limit the growing public health and economic burden of this disease," the NIH scientists said.

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