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

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

In a recently published study in Morbidity and Mortality Weekly Report Researchers examined the prevalence of human immunodeficiency virus (HIV) and other recent sexually transmitted infection (STI) diagnoses in individuals with monkeypox.

Lernen: HIV und sexuell übertragbare Infektionen bei Menschen mit Affenpocken – Acht US-Gerichtsbarkeiten, 17. Mai bis 22. Juli 2022. Bildnachweis: Berkay Ataseven/Shutterstock

background

The current monkeypox outbreak, caused by monkeypox virus, which belongs to the same family of viruses as 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 highlights the need to understand the association of HIV and other sexually transmitted diseases with monkeypox clinical outcomes so that public health decisions regarding vaccination and treatment can prioritize high-risk groups.

About studying

The present study used HIV, monkeypox, and other sexually transmitted disease surveillance data from eight jurisdictions in the United States to analyze and correlate HIV infections and STI diagnoses within the previous 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 among individuals diagnosed with monkeypox was calculated. The HIV surveillance data were also used to determine the patient's HIV care status, use of antiretroviral therapy, time of diagnosis, and most recent CD4 count, which indicates the strength of the immune system.

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

Results

The study found that HIV prevalence was 38% among the 1,969 monkeypox patients diagnosed between May 17 and July 22, 2022. The prevalence of one or more reportable 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 hospitalization was higher among people with HIV infection (8%) than among people without HIV (3%). Among monkeypox patients diagnosed with HIV infection, 82% had evidence of viral suppression, 92% had received HIV treatment in the previous year, and 78% had CD4 counts of 350 per microliter or higher.

HIV prevalence among monkeypox patients varied depending on demographic factors. People aged 18 to 24 had a lower HIV incidence than people aged 55 and over. Race and ethnicity were also factors in varying the prevalence of HIV among monkeypox patients. African American 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 in patients with HIV infection than in patients without HIV. Unsuppressed HIV load in monkeypox patients was also associated with symptoms such as lymphadenopathy, pruritus, rectal bleeding, and bloody stools. Low CD4 levels (<350 per microliter) in monkeypox patients with concurrent HIV infection were associated with a higher incidence of fever and generalized pruritus.

While the national estimate of eligible individuals receiving 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 among individuals with monkeypox infections. The prevalence of monkeypox also appears to be higher among MSM, who have a higher incidence of HIV and STI infections than the general population. In addition, HIV co-infection in monkeypox patients also shows a higher incidence rate in 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 previous year suggests a possible bias that individuals with known HIV infections or STIs are more likely to approach sexual health providers when they develop monkeypox symptoms. Likewise, HIV and sexual health 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.

In summary, 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 sexually transmitted diseases. The authors recommend routine HIV and STI screening and increased access to HIV treatment and PrEP for individuals screened for monkeypox. Regular surveillance and matching of monkeypox cases with HIV and STI diagnoses can help establish effective public health measures and interventions against monkeypox.

Reference:

• Curran KG, Eberly K., Russell OO, et al. HIV and Sexually Transmitted Infections Among Persons with Monkeypox – Eight US Jurisdictions, 17. Mai–22. Juli 2022. MMWR Morb Mortal Wkly Rep 2022; 71:1141–1147. doi: http://dx.doi.org/10.15585/mmwr.mm7136a1 https://www.cdc.gov/mmwr/volumes/71/wr/mm7136a1.htm

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