New CDC research shows a high incidence of severe MPV (monkeypox) cases for people with untreated HIV, which makes HIV testing and treatment critical for people in high-risk categories for MPV.
The MPV outbreak has largely subsided, both in New York City and nationally, thanks to high uptake of vaccines and behavior changes, but MPV is disproportionately affecting lower income people in communities of color who lack equitable access to health care. These communities also face significantly higher risk for HIV.
A Nov. 4 CDC study found that 82% of people diagnosed with very serious MPV infections also were living with HIV, which was untreated in almost all cases, so they had severely weakened immune systems.
The CDC study examined cases for 57 patients hospitalized with severe MPV, of whom 12 died. Of those, 47 were living with HIV–but only four of them were taking HIV antiretroviral medication. Over two-thirds of the hospitalized MPV patients were Black and almost one-fourth were homeless. Many also experienced delays in getting MPV treatment.
MPV and HIV are syndemic outbreaks, which means epidemics that interact with each other, according to a recent MPV update, “Addressing Monkeypox Holistically,” co-authored by Dr. Demetre Daskalakis, the Monkeypox National Response Deputy Coordinator, and National AIDS Policy Director Harold Phillips, with other top White House HIV and AIDS experts.
“Monkeypox is not a virus that lives in isolation. It exists as part of a number of acute and chronic outbreaks and health challenges that interact with each other and can be impacted by social circumstances that worsen disease outcomes,” the White House report explains.
“These [CDC] statistics make it clear the need to continue an aggressive and comprehensive approach to address monkeypox, HIV, STIs, homelessness, and mental health together,” the White House’s MPV update urged.
There is a high overlap between MPV and HIV. A Sept. 9 CDC study found that almost 40% of people diagnosed with MPV also were living with MPV, and over 40% had been diagnosed with an STI in the year before the MPV diagnosis. The CDC subsequently reported that among men who have sex with men (MSM), between 28% to 51% of those diagnosed with MPV were also living with HIV, for those with known HIV status. That study examined US, EU, and UK surveillance data as of Oct. 31.
Currently, there is no clear indication that people living with HIV are more likely to contract MPV after exposure, but rather, than MPV affects immunocompromised people more severely, according to the CDC.
“Monkeypox and HIV have collided with tragic effects,” said Dr. Jonathan Mermin, the CDC’s Monkeypox Incident Commander. “Access to monkeypox and HIV prevention and treatment matters–for people’s lives and for public health.”
MPV and HIV Prevention
Prompt treatment for both MPV and HIV produces better outcomes, so the Biden administration’s HIV/AIDS experts recommend that sexually active people with MPV symptoms also get tested for HIV and STIs and be offered prevention or treatment services.
“HIV prevention and care mitigates the impact of monkeypox on the health of individuals living with or at-risk for both infections. And, linkage to HIV care and treatment is critical to protect individuals from a variety of health threats, including Monkeypox,” the White House update recommended.
The Biden administration is working closely with community-based organizations like GMHC, the LGBTQ community and local public health agencies to combat the MPV outbreak using this holistic approach.
GMHC has stepped up its outreach around HIV/STI testing, care, prevention, and MPV vaccine navigation to reach the Black and Latinx communities that are most at risk for both MPV and HIV.
The agency started a focused outreach initiative in the Bronx earlier this fall to mitigate the MPV outbreak, thanks to an MPV Awareness Prevention Partnership (MAPP) grant from the New York City Department of Health and Mental Hygiene.
GMHC’s outreach workers are focusing on Bronx neighborhoods that collectively make up over half of NYC’s COVID-19 cases, with a high rate of other health disparities, to offer linkage to MPV vaccinations, HIV/STI testing and care, as well as to PrEP (pre-exposure prophylaxis) for HIV prevention.