HIV and Sexually Transmitted Infections Among Persons with Monkeypox - Eight U.S. Jurisdictions, May 17-July 22, 2022

Abstract

High prevalences of HIV and other sexually transmitted infections (STIs) have been reported in the current global monkeypox outbreak, which has affected primarily gay, bisexual, and other men who have sex with men (MSM) (1-5). In previous monkeypox outbreaks in Nigeria, concurrent HIV infection was associated with poor monkeypox clinical outcomes (6,7). Monkeypox, HIV, and STI surveillance data from eight U.S. jurisdictions* were matched and analyzed to examine HIV and STI diagnoses among persons with monkeypox and assess differences in monkeypox clinical features according to HIV infection status. Among 1,969 persons with monkeypox during May 17-July 22, 2022, HIV prevalence was 38%, and 41% had received a diagnosis of one or more other reportable STIs in the preceding year. Among persons with monkeypox and diagnosed HIV infection, 94% had received HIV care in the preceding year, and 82% had an HIV viral load of <200 copies/mL, indicating HIV viral suppression. Compared with persons without HIV infection, a higher proportion of persons with HIV infection were hospitalized (8% versus 3%). Persons with HIV infection or STIs are disproportionately represented among persons with monkeypox. It is important that public health officials leverage systems for delivering HIV and STI care and prevention to reduce monkeypox incidence in this population. Consideration should be given to prioritizing persons with HIV infection and STIs for vaccination against monkeypox. HIV and STI screening and other recommended preventive care should be routinely offered to persons evaluated for monkeypox, with linkage to HIV care or HIV preexposure prophylaxis (PrEP) as appropriate.

Conflict of interest statement

All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. Laura H. Bachman reported royalties from editing a textbook, “Sexually Transmitted Infections in HIV-Infected Adults and Special Populations.” Leandro A. Mena reported receiving grants or contracts in the past 36 months from Gilead Sciences, GSL/ViiV Healthcare, Merck, SpeedDX, Visby Medical, Becton, Dickinson & Company, Evofem, Roche, Janssen, Lupin, Binx Health, Click Diagnostics, Westat, and Rheonix; consulting fees from Gilead Sciences, ViiV Healthcare, Merck, and Roche; and participation on data safety monitoring boards for Gilead Sciences and Merck. No other potential conflicts of interest were disclosed.

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Signs and symptoms of monkeypox,, by HIV infection status — eight U.S. jurisdictions, May 17–July 22, 2022 * Persons with self-reported HIV infection who did not match to local HIV surveillance data (39) were excluded from the analysis. † Signs and symptoms were not mutually exclusive. § Percentages calculated using nonmissing data. Overall, 1,707 persons had data available for signs and symptoms except proctitis, including 1,082 persons without diagnosed HIV infection and 625 persons with diagnosed HIV infection. For proctitis, data were available for 393 persons without diagnosed HIV infection and 304 persons with diagnosed HIV infection. ¶ Eight state and city or county jurisdictions independently funded for HIV surveillance: California (including Los Angeles County and San Francisco), District of Columbia, Georgia, Illinois (including Chicago), and New York (excluding New York City).