Nail Disorders in Patients Living with HIV Coinfected with Monkeypox: A Clinical Study in 69 Mexican Cases

Abstract

<b><i>Introduction:</i></b> Several infectious diseases can present nail manifestations, which may be useful for diagnosis and prognosis, and only a few reports have been made regarding monkeypox (mpox). The objective of this study was to describe the clinical characteristics of nail alterations in patients living with HIV coinfected with mpox. <b><i>Methods:</i></b> A prospective, cross-sectional study included patients living with HIV/AIDS, coinfected with mpox. We examined all 20 nails in search of nail plate alterations. Patients were divided into two groups, with and without nail disease, and the CD4 count was noted according to the Centers for Disease Control and Prevention (CDC) classification. A χ<sup>2</sup> or Fisher’s exact test for qualitative variables and Mann-Whitney U and Kruskal-Wallis tests with post hoc Bonferroni test for quantitative variables were used to compare them. Data were analyzed with the SPSS Statistics 25 software. <b><i>Results:</i></b> Sixty-nine patients were included. The frequency of nail involvement was 58%. Papulonodular lesions were the most frequent type identified, with 21 cases (30.4%). A significant difference was observed between patients with nail disease versus median CD4 count (160 vs. 700/mm<sup>3</sup>; <i>p</i> = 0.002) and median HIV viral load (45,000 vs. 900/mL; <i>p</i> = 0.009). When comparing the characteristics of the nail lesions with the CDC Classification System for HIV infection by the CD4 count, a significant difference was observed in foot involvement, splinter hemorrhages, papulo-nodular lesions, anonychia, onychomadesis, acute paronychia, and nail bed ulcer-atrophy (<i>p</i> < 0.05). <b><i>Conclusions:</i></b> The frequency of nail lesions is high in patients living with HIV coinfected with mpox. In addition, they tend to be more destructive in patients with lower CD4 counts and higher viral loads.