Monkeypox, HIV Co-Infection Is Common, According to CDC Study

About 40% of people monkeypox also had HIV, according to a CDC study that included almost 2,000 monkeypox cases in the U.S. that occurred during the first two months of the outbreak.

Researcher at the U.S. Centers for Disease Control and Prevention (CDC) found an association between among monkeypox, HIV and other sexually transmitted infections (STIs).

In findings reported in the Sept. 9, 2022, issue of the CDC’s Morbidity and Mortality Weekly Report (MMWR) researchers looked at 1,969 cases that occurred during the first two months of the monkeypox outbreak (May 17-July 22, 2022) in the United States and discovered that approximately 40% also had HIV. Of those co-infected, 82% had achieved HIV viral suppression.

Lead author Kathryn G. Curran, Ph.D., and a large team of fellow researchers noted, though, that that people with established connections to HIV and sexual healthcare services are probably more likely to recognize monkeypox symptoms and seek care.

“Persons with monkeypox signs and symptoms who are not engaged in routine HIV or sexual health care, or who experience milder signs and symptoms, might be less likely to have their monkeypox virus infection diagnosed,” said John T. Brooks, M.D., chief medical officer for the CDC’s monkeypox outbreak response team. “To ensure appropriate diagnosis and treatment, it is important that healthcare providers who do not specialize in HIV or sexual health become familiar with the clinical guidance for monkeypox diagnosis and treatment.”

The association between HIV and monkeypox is not limited to the U.S. World Health Organization data show that around the world, nearly 45% of reported monkeypox cases have been found in those living with HIV.

Monkeypox and HIV both spread through sexual contact, and most prevalent among various networks of gay, bisexual and other men who have sex with men.

The research findings reported in MMWR also show that 41% of the people with monkeypox have a history of other sexually transmitted infections, including chlamydia, gonorrhea or syphilis.

Demetre Daskalakis, M.D., M.P.H., deputy coordinator for the White House National Monkeypox Response and director of the CDC’s Division of HIV Prevention, noted the monkeypox numbers speak more to sexual networks and less about those being HIV positive — and that’s where combating future cases comes in.

Among the cases of monkeypox patients without HIV, 67% reported use of HIV preexposure prophylaxis (PrEP).

Another finding was that 8% of those co-infected monkeypox and HIV were hospitalized compared 3% without HIV. The study authors said the difference may be a matter of doctors being extra cautious with patients with both monkeypox and HIV.

The CDC investigators suggested public health officials utilize systems of administering HIV care to reduce monkeypox incidence in vulnerable populations.