The ongoing outbreak of mpox, which was formerly known as monkeypox, poses a particular threat to HIV/AIDS patients and others with compromised immune systems. Here are ways we can help protect these patients.
The ongoing mpox, formerly known as monkeypox, outbreak poses a particular threat to HIV/AIDS patients and others with compromised immune systems. While similarities between these two viral diseases exist, there are also important epidemiological, molecular, pathological, and clinical differences. Examining these similarities and differences, alongside prevention strategies, can provide valuable insights for healthcare and public health professionals working to control mpox today.
Molecular, Pathological, and Clinical Differences
We know that both mpox and HIV are viral diseases, but there are other details that can help inform strategies to provide culturally humble care for immunocompromised patients, which are summarized in Table 1 below.
While both mpox and HIV/AIDS are viruses, their taxonomies differ as a poxviridae and a retroviridae, respectively. Both mpox and HIV/AIDS initially affected certain demographic groups more than others. The transmission of mpox is most frequently through direct contact and HIV/AIDS is transmissible through bodily fluids including breastmilk and sharing of needles.
The Path Forward
Compared to other countries that have not historically reported mpox infections, it’s a concern that the U.S. reported the highest number of cases and deaths for 2022-2023. Infectious diseases will likely remain a threat to public health, but effective vaccinations and treatments can help reduce the spread. To date, more than 1.2 million vaccinations have been administered with only an estimated 23 percent of those at higher risk have been fully vaccinated. Applying effective strategies to contain and prevent viral outbreaks are needed. Key strategies include assessment of risk, contact tracing, anti-stigma messaging, strategic vaccination, and ensuring treatment access.
- Assessing Risk Factors and Reducing Exposure Risks: Evaluation of patient risk factors, such as potential exposures, travel history, skin lesions, sexual behaviors, and tailoring educational and counseling messages for preventing mpox infection, including reduced exposure to mpox and other risky behaviors. Access to timely testing for diagnosis is also warranted.
- Strategic Vaccination Planning:Due to its limited availability, the two-dose vaccine must be prioritized for those who are at higher risk. Studies show that the mpox vaccine can still provide protective benefit for immunocompromised patients. According to the CDC, the mpox vaccine is recommended for patients if they have/had:
- Known or suspected exposure to someone with mpox or is at risk of mpox or mpox itself through intimate contact or sex
- A weakened immune system
- One or more sexually transmitted infections
- Contact Tracing and Risk Reduction: Effective contact tracing and early risk reduction messaging can help reduce the spread of mpox by identifying and communicating with individuals that may be affected.
- Anti-Stigma Messaging: Reducing mpox spread requires balancing destigmatization with education and resources for high-risk groups. We must build trust and transparency to communicate clear health information and interventions.
- Accessible Treatment: Treatments for both infections exist but remain restricted and expensive. Accessible post-exposure prophylaxis is recommended for those exposed to mpox, which can aid in reducing its severity and contagiousness. Tecovirimat is recommended by the CDC to treat mpox in immunocompromised patients or additional therapeutic options, such as cidofovir, brincidofovir, and vaccinia immune globulin intravenous, as clinically appropriate.
Vigilance in educating and ensuring access to treatments for those who are the most vulnerable can help reduce the potential for a larger and/or reoccurring mpox outbreak. By combining preventive education, vaccination when eligible, risk-reducing strategies, and access to testing and treatments, we can help protect those most at risk.
Table 1. Summary of Mpox and HIV/AIDS
REFERENCES
Centers for Disease Control and Prevention. (2023, August 30). Mpox. Centers for Disease Control and Prevention. https://www.cdc.gov/poxvirus/mpox/index.html
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