Monkeypox and HIV in the Canary Islands: A Different Pattern in a Mobile Population

Abstract

Background. The clinical and epidemiological data of the recent outbreak of monkeypox (MPX) differ from previous reports. One difference is the epidemiological profile; the disease mainly affects a subgroup of MSM (men who have sex with men) with high-risk sexual behaviors, frequently persons living with human immunodeficiency virus (PLHIV). Methods. In this observational analysis, all patients with PCR (polymerase chain reaction)-confirmed MPX attending an Infectious Diseases and Tropical Medicine Unit in Gran Canaria (Spain) between May and July 2022 were considered. Results. In total, 42 men were included; 88% were identified as MSM, with a median age of 40 years. Only 43% were born in Spain. All the patients had systemic symptoms and skin lesions. The distribution of lesions was more frequent in the genital/anal region, and the involvement of hands and feet was less common. Fever and lymphadenopathies were less frequent than in other series. Other unusual manifestations were proctitis, pharyngitis and penile–scrotal edema. Half of the patients had other associated infections (mainly STIs, sexually transmitted infections), and 60% of the monkeypox patients had PLHIV (People Living with HIV). When comparing the clinical characteristics between HIV-positive and -negative patients, we found three main differences: (i) a higher frequency of perioral lesions, (ii) a higher frequency of pharyngitis and (iii) a higher number of sexually transmitted infections in HIV-positive patients. Conclusions. The clinical findings in this outbreak of MPX had great variability in presentation. Several clinical differences were found in PLHIV-coinfected patients.

Mpox infection in people living with HIV

“…[21] performed the retrospective cohort study published in this issue of 322 individuals in the United States to examine the baseline characteristics, clinical manifestations, and healthcare utilization among people with Mpox infection with or without underlying HIV coinfection. Roughly 29% were PWH and this frequency is line with that observed in other studies (28–51%) [1,7,8,10,12,19]. They observed high rates of symptomatic disease in PWH who also required greater utilization of healthcare resources compared to HIV uninfected counterparts.…”

“…In Mpox from non-endemic regions, the disease has predominantly been in gay, bisexual, and other men who have sex with men (MSM) [1,[7][8][9][10][11][12][13] with increased prevalence of HIV and concomitant sexually transmitted infections (STIs) [13]. Mpox has an incubation period of 4-21 days and is a self-limited disease lasting 2-4 weeks without treatment, but this is not the case for all.…”

Clinical Characteristics of Human Mpox (Monkeypox) in 2022: A Systematic Review and Meta-Analysis

“…We assessed the eligibility of the remaining 1349 studies by reading full-text papers: 1112 did not report clinical features and epidemiological characteristics of mpox; one reported duplicated cases (the one with more detailed information was included), and three reported cases before 6 May 2022 (cases confirmed in 2017–2021), one reported asymptomatic cases. Seventy-seven studies [ 4 , 8 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 ,…”

“…Seventy-seven studies [ 4 , 8 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , …”

Demographic, Epidemiologic, and Clinical Characteristics of Human Monkeypox Disease Pre- and Post-2022 Outbreaks: A Systematic Review and Meta-Analysis

“… Pooled frequency of genitalia involvement in post-2022 studies. Tarín-Vicente, 2022 [ 27 ], Angelo, 2022 [ 28 ], Betancort-Plata, 2022 [ 29 ], Caria, 2022 [ 30 ], Vanhamel 2022 [ 31 ], Girometti, 2022 [ 33 ], Orviz, 2022 [ 34 ], Hoffmann1, 2022 [ 35 ], Cobos, 2022 [ 36 ], Hoffmann2, 2022 [ 37 ], Van Ewijk, 2022 [ 38 ], Mailhe, 2022 [ 39 ], Nunez, 2022 [ 40 ], Catala, 2022 [ 41 ], Cassir, 2022 [ 42 ], Pascom, 2022 [ 70 ], Suner, 2022 [ 43 ], Maldonado, 2023 [ 44 ]. …”