BACKGROUND: Over 85,000 mpox cases have been reported worldwide. A large proportion of them are people who live with HIV/AIDS (PLWHA), some series report percentages over 50%. Mpox has been hypothesized to be more severe in PLWHA. However, no studies have conclusively shown worse outcomes among PLWHA. We aim to study the association between HIV and severe mpox.
METHODS: We used the national epidemiologic surveillance system in Mexico to obtain data on confirmed-mpox cases. A case report format was submitted to the General Epidemiology Directorate with clinical data on people with mpox. We used this data to construct logistic regression models using HIV as the main exposure of interest and adjusting for age, gender, and mechanism of HIV transmission. We defined severe mpox as that requiring hospitalization or that resulted in death.
RESULTS: 3291 mpox cases were diagnosed from May-November 2022. 1930 (58.6%) were in PWLHA, 97% were men, and 87% identified as men-who-have-sex-with-men. The epidemiologic curve of mpox cases is shown in Figure 1. Logistic regression analyses and the proportion of persons that developed a given outcome or symptom are shown in Figure 2. HIV status was associated with an increased odds of severe mpox, generalized rash, fever, fatigue, vomit, diaphoresis, painful lesions, diarrhea, and lymphadenopathies.

Figure 1
Figure 2

CONCLUSIONS: Several symptoms, such as fever and fatigue, were more common in PLWHA. Importantly, HIV conferred an increased risk of severe mpox. This underlines the importance of directing preventive measures and clinical trials of therapeutics and preventive interventions towards this population at risk.

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