The CDC report shows that people with monkeypox have higher than expected HIV and STI rates

In a recently published study in Morbidity and Mortality Weekly ReportThe researchers looked at the prevalence of human immunodeficiency virus (HIV) and other recent diagnoses of sexually transmitted infections (STIs) in people with monkeypox.

background

The current outbreak of monkeypox, caused by the monkeypox virus, which belongs to the same virus family as the smallpox virus, has a high incidence rate among gay and bisexual individuals and other men who have sex with men (MSM).

Previous outbreaks of the disease in Nigeria have shown associations between HIV infection and poor clinical outcomes when co-infected with monkeypox. This underscores the need to understand the link between HIV and other STDs and monkeypox clinical outcomes so that public health decisions about vaccination and treatment can prioritize high-risk groups.

About the study

The present study used surveillance data for HIV, monkeypox and other sexually transmitted diseases from eight United States jurisdictions to analyze and correlate HIV infection and STI diagnoses within the past year with individuals with monkeypox infections. The data was also used to assess the severity of monkeypox cases in relation to HIV infection status.

The prevalence of HIV infection in individuals diagnosed with monkeypox was calculated. HIV surveillance data was also used to determine the patient’s HIV care status, use of antiretroviral therapy, time of diagnosis and last CD4 count, which indicates immune system strength.

STI surveillance data was analyzed to capture diagnoses of chlamydia, syphilis, and gonorrhea within the past 12 months in subjects infected with monkeypox. Monkeypox symptoms and clinical outcomes in infected individuals were also correlated with HIV infection status.

Results

The study found that among the 1,969 monkeypox patients diagnosed between May 17 and July 22, 2022, HIV prevalence was 38%. The prevalence of one or more notifiable STIs among diagnosed monkeypox patients was 41%. The percentage of monkeypox infected people with HIV and one or more STIs diagnosed in the previous year was 18.

The incidence of monkeypox hospitalizations was higher in people with HIV infection (8%) than in people without HIV (3%). Among monkeypox patients diagnosed with HIV infection, 82% had evidence of viral suppression, 92% had received prior HIV treatment, and 78% had CD4 counts of 350 per microliter or greater.

HIV prevalence in monkeypox patients varied based on demographic factors. People between the ages of 18 and 24 had a lower incidence of HIV than those aged 55 and over. Race and ethnicity were also factors in varying the prevalence of HIV in monkeypox patients. Black MSM had the highest prevalence (63%), followed by Hispanics (41%), non-Hispanic Whites (28%), and non-Hispanic Asians (22%).

In addition, some monkeypox symptoms, such as rectal pain and bleeding, tenesmus, proctitis, and bloody stools, were reported more frequently by HIV-infected patients than non-HIV patients. Unsuppressed HIV burden in monkeypox patients was also associated with symptoms such as lymphadenopathy, itching, rectal bleeding and bloody stools. Low CD4 levels (<350 per microliter) in monkeypox patients co-infected with HIV were associated with a higher incidence of fever and generalized pruritus.

While the national estimate of eligible individuals who received a prescription for HIV pre-exposure prophylaxis (PrEP) was 25%, the authors report that nearly two-thirds of monkeypox patients without HIV co-infection reported using HIV PrEP.

Conclusions

Overall, the study indicates a prevalence of HIV infection and recently diagnosed STIs in individuals with monkeypox infections. The prevalence of monkeypox also appears to be higher in MSM, who have a higher incidence of HIV and STI infection than the general population. In addition, HIV co-infection in monkeypox patients also shows a higher incidence rate among African-American MSM, Hispanic MSM, and MSM over 55 years of age.

According to the authors, the co-occurrence of monkeypox cases with STI diagnoses in the prior year suggests a possible bias that individuals with known HIV infection or STIs are more likely to approach sexual health providers if they develop monkeypox symptoms. Likewise, HIV and sex medicine professionals could recognize symptoms of monkeypox and test for the virus, compared to health care providers who have no experience in HIV and STI care.

Taken together, the results suggest that monkeypox transmission may be associated with individuals with HIV infection, indicating the importance of prioritizing monkeypox vaccination for individuals diagnosed with HIV infection and STDs. The authors recommend routine HIV and STI screening and improved access to HIV treatment and PrEP for people screened for monkeypox. Regular monitoring and matching of monkeypox cases to HIV and STI diagnoses can help establish effective public health measures and interventions against monkeypox.