By Sola Ogundipe
EXPERTS have warned that Monkeypox among people with unsuppressed HIV and greater immune impairment is likely to become a growing concern as the outbreak increasingly moves into lower-income communities, affecting people and groups that have higher HIV rates but are less likely to be in care and on effective treatment.
According to an Aidsmap report, monkeypox is now disproportionately affecting Black and Latino men.
Worse still, African countries, where monkeypox is endemic, are yet to receive vaccines to prevent the disease, even as the number of new monkeypox cases across the globe decreased for the second consecutive week, the World Health Organisation, WHO, puts the regional risk has at moderate in Africa.
A New England Journal of Medicine study says there are many monkeypox cases reported among men living with HIV, but no sign yet of poorer outcomes
While a substantial proportion of people with monkeypox are living with HIV, people with well-controlled HIV and a high CD4 count do not appear to have more severe monkeypox illness, except for those with more advanced HIV disease. It is argued that HIV-positive people may not respond as well to monkeypox vaccines, and so should receive the most effective regimen possible.
Worldwide, there are now about 48,000 cases, mostly outside countries in central and West Africa where the virus is endemic.
The Aidsmap publication noted that the proportion of people with monkeypox who are living with HIV is high in several large case series.
In a study on monkeypox outcomes in people with HIV, Professor Chloe Orkin of Queen Mary University of London and colleagues wrote that most had well-controlled HIV: 95 percent had an undetectable viral load (less than 50 copies) and the median CD4 count was high, at 680.
“The clinical presentation was similar among persons with HIV infection and those without HIV infection,” the study authors wrote. HIV-positive people were not more likely to be admitted to hospital, but two of the more serious complications occurred in people with HIV.
“Whilst people with HIV account for more than 40 percent of cases so far, it is reassuring that HIV status was not linked with monkeypox severity,” according to the British HIV Association chair Dr Laura Waters. However, this may not be the case for people with poorly controlled HIV. People with HIV are more prone to prolonged illness and higher mortality.