People with HIV could develop more severe mpox

People with HIV could develop more severe mpox

Monkeypox, now known as mpox, has continued to make waves since it began an unusual outbreak in May 2022. A recent study found that people living with HIV, especially if they have weakened immune systems, may develop symptoms more severity of the disease.

The World Health Organization reports that, at the end of January, there were more than 85,000 confirmed cases of mpox in 110 countries. At the time, the outbreak was classified by the agency as an international public health emergency because the virus that caused the disease was endemic, that is, it only occurred in one territory, in this case, in some African countries.

Outside of the central and eastern region of the African continent, the vast majority of cases in the rest of the world have affected gay, bisexual and other men who have sex with men, who mainly acquired the infection during sexual activity.

Men with HIV, the most affected

In the few countries that have rigorously tracked the mpox outbreak, it has been observed that those living with HIV make up a large percentage of cases. In the United Kingdom, for example, they reach 25%, but in other European countries the proportion is close to 40%, as reported by the website, which specializes in medical information on HIV.

Similarly, the few studies that reviewed the relationship between HIV and mpox found no significant differences in disease development between HIV-negative men and those with HIV but on effective antiretroviral therapy, reflected in a strong immune system.

However, a study by researchers at the University of Georgia in the United States found that men with HIV but without antiretroviral treatment or who had weakened immune systems had more severe symptoms of mpox, often leading them to be hospitalized.

More serious consequences

The Centers for Disease Control (CDC) in the United States had registered, as of January 27, 30,000 cases of mpox in that country. About 40% of them were living with HIV, but the rate grows to 70% in some states. A significant proportion of all mpox cases occurred in black and Latino men.

Last November, the CDC published an analysis of data collected from clinic visits given to 57 people hospitalized for mpox. Although 47 of them (all men) had HIV, only 4 were on antiretroviral treatment. Also, among those who knew their CD4 cell count (immune cells that are destroyed by HIV), 72% had very low numbers, indicating a severely weakened defense system.

All hospitalized men had severe skin symptoms and two thirds also had mucosal lesions. 30% of them required intensive therapy and 12 died.

Most frequent symptoms

On the other hand, the University of Georgia study was based on data from a research network called TriNetX, with which they were able to observe 322 cases of adults with mpox, 29% of whom were living with HIV.

Regarding the symptoms of mpox, the research detailed that those who also had HIV were more likely to have a rash (25% of them, compared to 11% of men without HIV), rectal pain (25% compared to 10%) , rectal or anal abscesses (11% vs 0%), pneumonia (11% vs 0%), and swollen tonsils (11% vs 0%).

In addition, 53% of men with HIV needed to go to the emergency department, compared with 29% of men without HIV. 11% of the former were hospitalized, compared to only 4% of the latter.

The research team concluded that their study shows the importance of clinicians considering potential complications in people with HIV who contract mpox, “particularly those with severe or atypical symptoms.”

At AHF Latin America and the Caribbean we know that mpox is affecting men who could receive a preventive vaccine and who require specialized care, but for various reasons cannot access it. If you have questions about this or other infections related to sexual activity, such as HIV, come to our offices in your country and learn about all our services.