BACKGROUND: Since May 2022, the ongoing multi-country mpox outbreak has primarily affected gay, bisexual and other men who have sex with men (GBMSM). In some countries up to 50% of cases have been reported among people living with HIV (PLHIV), and although HIV is not a risk factor for mpox, it might lead to increased risk for complications and severe disease.
METHODS: We analysed data from January to December 2022 from the mpox global case-based surveillance system, established by WHO in collaboration with regional and national partners. We included all cases with available information on HIV status, and described epidemiological, clinical characteristics and outcomes in PLHIV. We used binomial logistic regression to explore whether living with HIV and immunosuppression (reported as Yes/No) were risk factors for hospitalization, ICU admission or death.
RESULTS: Information on HIV status was available for 44% (34,973/80,843) of reported cases. Of these, 48% (16,788/34,973) were PLHIV, most of whom were male (99%; 16,497/16,550). Among PLHIV with information, 92% reported being GBMSM (12,071/13,166), 85% aged 18-44 years old (14,197/16,782), and sexual contact was reported as the main route of acquisition in 63% of cases (5,360/8,529). Clinical symptoms among PLHIV with information included any rash (79%; 10,248/12,997), fever (64%), genital rash (53%), lymphadenopathy (35%) and headache (35%). Among PLHIV, immunosuppression was reported in 5,023 cases, 735 were hospitalized, 20 admitted to intensive care, and 23 died. When compared to cases who were HIV-negative and not immunosuppressed, immunosuppressed PLHIV were found to be at higher risk for hospitalization (OR=2.00, CI=1.64-2.43, p=<0.001) as were those who were immunosuppressed and HIV-negative (OR=3.56, CI=1.80-7.01, p=<0.001). Living with HIV alone was not a risk factor. Due to the small sample size, no risk factors for ICU admission and death were found.
CONCLUSIONS: Among cases with mpox, PLHIV were not at increased risk for hospitalization unless immunosuppressed. Given that uncontrolled HIV might have led to disproportionate mpox morbidity, health systems need to ensure PLHIV are aware of their diagnosis, linked to care, on effective antiretroviral treatment and achieve viral suppression. For individuals with unknown HIV status, mpox testing can be an opportunity for HIV testing, prevention and care.