Mpox and HIV: a Narrative Review

Abstract

Purpose of review: We reviewed the available literature on mpox in People with HIV (PWH). We highlight special considerations of mpox infection related to epidemiology, clinical presentation, diagnostic and treatment considerations, prevention, and public health messaging in PWH.

Recent findings: During the 2022 mpox outbreak, PWH were disproportionally impacted worldwide. Recent reports suggest that the disease presentation, management, and prognosis of these patients, especially those with advanced HIV disease, can widely differ from those without HIV-associated immunodeficiency. Mpox can often be mild and resolve on its own in PWH with controlled viremia and higher CD4 counts. However, it can be severe, with necrotic skin lesions and protracted healing; anogenital, rectal, and other mucosal lesions; and disseminated organ systems involvement. Higher rates of healthcare utilization are seen in PWH. Supportive, symptomatic care and single or combination mpox-directed antiviral drugs are commonly used in PWH with severe mpox disease. Data from randomized clinical control trials on the efficacy of therapeutic and preventive tools against mpox among PWH are needed to better guide clinical decisions.

Keywords: AIDS; HIV; Mpox; Orthopoxvirus; Tecovirimat; Vaccina virus.

Fig. 1

Figure mpox lesions in patients* with HIV. A: Coalescent ulcers. B: Multiple large ulcers pustules in hands. C: Coalescent lesions in the perianal region. D: Single mpox ulcer in the soft palate. E: Large coalescent, necrotic facial and scalp lesions F: Eschar in the lower extremity. Photos by Alexandra Dretler, Jonathan Colasanti, and Valeria D. Cantos *Patients have provided written consent to publish these photographs