Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Nov 30;8(11):e013126.
doi: 10.1136/bmjgh-2023-013126.

Mpox (monkeypox) risk and mortality associated with HIV infection: a national case-control study in Nigeria

Adesola Yinka-Ogunleye  1   2 , Mahmood Dalhat  3   4 , Afolabi Akinpelu  5 , Olusola Aruna  6 , Fatima Garba  7 , Adama Ahmad  5 , Adesola Adeleye  5 , Iliya Botson  5 , Bamidele Oluwafemi  5 , Oladipo Ogunbode  8 , Lateefat Amao  8 , Udeme Ekripo  9 , Gambo Gumel Aliyu  10 , Ifedayo Adetifa  11   12 , Chikwe Ihekweazu #  11 , Ibrahim Abubakar #  2
Affiliations

Mpox (monkeypox) risk and mortality associated with HIV infection: a national case-control study in Nigeria

Adesola Yinka-Ogunleye et al. BMJ Glob Health. .

Abstract

Introduction: Recent outbreaks of mpox are characterised by changes in the natural history of the disease, the demographic and clinical characteristics of the cases, and widening geographical distribution. We investigated the role of HIV and other sexually transmitted infections (STIs) coinfection among cases in the re-emergence of mpox to inform national and global response.

Methods: We conducted a national descriptive and case-control study on cases in the 2017-2019 Nigerian mpox outbreak. Mpox cases were age, sex and geographical area matched each with two randomly selected controls from a representative national HIV/AIDS survey. Logistic regression was used to investigate the association between HIV infection and the risk of mpox acquisition and death.

Results: Among 204 suspected mpox cases, 86 were confirmed (median age 31 years (IQR 27-38 years), mostly males (61 cases, 70.9%). Three-fifths of mpox cases had serological evidence of one or more STIs with 27.9% (24/86) coinfected with HIV. The case fatality rate was 9.4% (8/86) and 20.8% (5/24) overall and in HIV positive cases respectively. Mpox cases were more likely to have HIV coinfection compared with an age, gender and geography-matched control group drawn from the general population (OR 45 (95% CI 6.1 to 333.5, p=0.002) and when compared with non mpox rash cases (7.29 (95% CI 2.6 to 20.5, p<0.0001)). HIV coinfection and young age were associated with mortality among mpox cases (aOR 13.66 (95% CI 1.88 to 98.95, p=0.010) and aOR 0.90 (0.82-0.97, p=0.008), respectively).

Conclusion: HIV infection was associated with a higher risk of contracting and dying from mpox. Children are also at high risk of death. STIs in mpox cases may be suggestive of high-risk sexual behaviours among these individuals.

Keywords: HIV.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1. A flow diagram showing number of confirmed mpox cases and the seropositivity of HIV, human immunodeficiency virus; HPV, human papillomavirus and HSV, herpes simplex virus among the cohort of suspected mpox cases studied.
See this image and copyright information in PMC

References

    1. World Health Organization . The global eradication of smallpox: final report of the Global Commission for the Certification of Smallpox Eradication. Geneva: World Health Organization; 1979.
    1. Sklenovská N, Van Ranst M. Emergence of Monkeypox as the most important orthopoxvirus infection in humans. Front Public Health. 2018;6:241. doi: 10.3389/fpubh.2018.00241. - DOI - PMC - PubMed
    1. Jezek Z, Szczeniowski M, Paluku KM, et al. Human Monkeypox: clinical features of 282 patients. J Infect Dis. 1987;156:293–8. doi: 10.1093/infdis/156.2.293. - DOI - PubMed
    1. Heymann DL, Szczeniowski M, Esteves K. Re-emergence of Monkeypox in Africa: a review of the past six years. Br Med Bull. 1998;54:693–702. doi: 10.1093/oxfordjournals.bmb.a011720. - DOI - PubMed
    1. Reed KD, Melski JW, Graham MB, et al. The detection of Monkeypox in humans in the Western Hemisphere. N Engl J Med. 2004;350:342–50. doi: 10.1056/NEJMoa032299. - DOI - PubMed

Publication types