Monkeypox worse for those with weakened immune systems, HIV, new data show
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Although the number of new monkeypox cases has slowed in recent weeks, new data published Wednesday show people with weakened immune systems, especially those with HIV, are at risk for severe disease.
The data, published in MMWR, summarized findings from 57 patients hospitalized with severe monkeypox between August and October, 47 of whom (82%) had HIV infection. Most patients were male, more than two-thirds were non-Hispanic Black and nearly one-quarter of patients (23%) were experiencing homelessness.
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The agency has confirmed 27,884 cases of monkeypox in the United States as of Oct. 21, most of which have been in gay, bisexual and other men who have sex with men, as well as those with HIV.
“Monkeypox and HIV have collided with tragic effects,” Jonathan H. Mermin, MD, MPH, the CDC’s monkeypox incident commander, said in a press release. “Today’s report reminds all of us that access to monkeypox and HIV treatment and prevention matters — for people’s lives and for public health.”
Overall, 17 patients (30%) received ICU-level care and 12 (21%) died. Among those who died, monkeypox was determined to be the cause of death or a contributing factor in five patients.
Among the 47 patients with monkeypox who also had HIV, four (9%) were receiving ART before they were diagnosed with monkeypox. There were also two patients with HIV who were undergoing chemotherapy for a hematologic malignancy, three were solid organ transplant recipients, and three were pregnant.
To extend the vaccine supply, U.S. officials in August announced a plan to allow providers to deliver fractional doses. The NIH is studying the efficacy of that approach.
Researchers wrote in the new report that health care providers should be testing all sexually active patients with suspected monkeypox for HIV at the time they test for monkeypox — unless their HIV status is known — and to start monkeypox therapy early, possibly before test results are known, to limit risk for severe disease.
The researchers also said their findings support the continued need for intense outreach to communities at most risk for monkeypox.
“Most patients in this cohort were Black men, and nearly one-quarter of cases occurred in persons experiencing homelessness. These findings likely reflect inequities in access to resources for the prevention, early diagnosis and treatment of HIV infection, as well as missed opportunities to engage groups that have socially or economically marginalized,” the researchers wrote. “Public health outreach should strive to engage all persons with HIV infection in care and to increase access to monkeypox vaccination, diagnosis and treatment.”
To address these issues, the CDC recently launched a vaccine equity pilot program to reach the most at-risk populations.
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