New Data Illuminates Monkeypox’s (MPV) Disparate Impact on People Living With HIV

The 2022 monkeypox (MPV) outbreak is disproportionately impacting people living with HIV, according to new data from the CDC.

A CDC report published September 8 found that 38% of MPV patients surveyed have HIV. 41% were recently diagnosed with an STI, and 61% had either HIV or an STI. Additionally, patients with HIV reported slightly higher rates of MPV-related hospitalization than patients without HIV (8% versus 3%, respectively).

Given these findings, the CDC now recommends that people with HIV and STIs be prioritized in distribution of the JYNNEOS vaccine, an existing smallpox vaccine being used to combat MPV. Healthcare providers are also advised to offer HIV and STI screenings to patients being evaluated for MPV, and to leverage existing HIV and STI care infrastructures “for monkeypox evaluation, vaccination, and other prevention interventions.”

CDC Data: MPV and HIV

This data is in line with data from the World Health Organization (WHO). On a global scale, nearly 45% of people with MPV whose status is known are HIV positive.

MPV spreads through direct skin-to-skin contact with an infected individual; contact with contaminated objects, fabrics, or surfaces; or, occasionally, contact with respiratory secretions from an infected individual. Right now, direct skin-to-skin contact during sex is the primary mode of infection. The CDC said MPV is most accurately described as “sexually transmissible” since sex is just one way it can spread. 

It is unclear whether MPV spreads via semen or vaginal fluids; however, the CDC recommends that people from high-risk communities wear condoms during sex in case there are MPV lesions present on a partner’s genitals, and to prevent the spread of known STIs, including HIV.

Anyone can get MPV, but gay and bi men and men who have sex with men account for the majority of the 21,800 reported cases in the U.S. However, the incidence of MPV cases among people with HIV is not typical of queer men, whose lifetime risk of HIV infection is about 17%. 

Researchers at the CDC are uncertain whether this link is correlational, or if having HIV increases a person’s likelihood of getting MPV. People with HIV tend to be very familiar and engaged with healthcare. As such, the high incidence of reported MPV cases in this population could be skewed since they are more likely to seek MPV testing and treatment.

Here’s what we do know about MPV and HIV: The JYNNEOS vaccine is currently recommended for people at high risk of exposure to MPV, including gay and bi men, people with HIV, and people with STIs. The JYNNEOS vaccine will not interfere with HIV pre-exposure prophylaxis (PrEP), so people on PrEP should continue taking it as directed post-MPV vaccination.

Importantly, people with HIV who are virally suppressed, or undetectable, are not at a higher risk of severe MPV illness. In fact, according to WHO’s MPV guidance, “People living with HIV on antiretroviral therapy with suppressed viral load are not considered to be immunosuppressed.” However, the inverse is also true: People with HIV who are not virally suppressed may be at risk of severe illness and death from MPV.

People with HIV who are at high risk of MPV exposure should take the same precautions as anyone else. In addition to vaccination, the CDC recommends temporarily reducing behaviors associated with MPV exposure or transmission, such as having multiple sex partners or engaging in one-time sexual encounters. According to one CDC survey of gay and bi men, nearly half of all respondents reported taking such precautions.

In a statement to GLAAD, Dr. Carlos del Rio, Distinguished Professor of Medicine in the Division of Infectious Disease at Emory University’s Rollins School of Public Health, stressed the need for further research on MPV and HIV co-infection. (Emory University is affiliated with The Gilead COMPASS Initiative®, created to address the HIV/AIDS epidemic in the Southern U.S.)

“The recent MMWR documenting the fact that 38% of persons with monkeypox also have HIV infection is consistent with other series globally, where 40–60% of the persons with monkeypox also have HIV infection,” Dr. del Rio said. “For this reason, it is imperative that vaccination be prioritized for people living with HIV, and that research studies be done in order to better understand the relationship between HIV and monkeypox.”

The 2022 MPV outbreak is also disproportionately impacting Black and Latinx gay and bi men. People in these communities are more likely to contract HIV in their lifetime, a phenomenon often attributed to racial inequities within the U.S. healthcare infrastructure. 

Despite racial disparities in MPV cases, Black and Latinx LGBTQ people are less likely to be vaccinated against MPV. MPV vaccine equity is an ongoing concern among healthcare advocates and public health officials. On August 30, the Department of Health and Human Services (HHS) announced an equity intervention pilot program to provide vaccines and educational resources to underserved communities.