From the Guidelines
HIV and monkeypox virus are distinct pathogens with no direct biological relationship, though they can coexist in the same individual, and individuals with HIV, particularly those who are immunocompromised, may be at a higher risk for severe monkeypox disease. The relationship between Human Immunodeficiency Virus (HIV) and Monkeypox virus is primarily one of opportunistic infection, where the compromised immune system of an HIV-positive individual can lead to more severe manifestations of monkeypox 1. Key points to consider include:
- HIV is a retrovirus that attacks the immune system, potentially leading to AIDS if untreated, while monkeypox is a DNA virus from the Orthopoxvirus genus that causes a rash illness.
- People living with HIV, especially those with low CD4 counts or untreated infection, may experience more severe monkeypox disease due to their compromised immune function 1.
- Current guidelines recommend that people with HIV who contract monkeypox receive the same antiviral treatments as HIV-negative individuals, but may need closer monitoring.
- It's also important to note that vaccinia vaccine, which can provide protection against orthopoxviruses like monkeypox, should not be administered to immunocompromised persons, including those infected with HIV 1.
- HIV medications do not prevent or treat monkeypox, and monkeypox treatments don't affect HIV, emphasizing the need for managing both infections separately but concurrently.
- For those with both infections, maintaining HIV treatment adherence is crucial while addressing the monkeypox infection, as the immune suppression caused by untreated HIV can allow for more severe manifestations of monkeypox.
From the Research
Relationship Between HIV and Monkeypox Virus
The relationship between Human Immunodeficiency Virus (HIV) and Monkeypox virus is an area of ongoing research, particularly given the recent outbreaks of Monkeypox and its disproportionate impact on certain populations, including men who have sex with men (MSM) and individuals living with HIV.
Key Findings
- Approximately half of the patients with Monkeypox virus infection who received tecovirimat were living with HIV infection, as reported in a study published in 2022 2.
- The median interval from initiation of tecovirimat to subjective improvement was 3 days and did not differ by HIV infection status, suggesting that HIV status may not significantly impact the effectiveness of tecovirimat treatment for Monkeypox 2.
- People living with HIV may be at an increased risk of adverse outcomes from Monkeypox and may require antiviral treatment, with studies indicating that antiretroviral drugs can be co-administered with antivirals for Monkeypox without significant adverse reactions 3.
- Tecovirimat, an antiviral drug, has shown efficacy in treating Monkeypox, including in patients with HIV, by inhibiting the Orthopoxvirus VP37 envelope wrapping protein, thus preventing enveloped virus formation 3, 4, 5, 6.
Treatment Considerations
- The use of antivirals such as tecovirimat, cidofovir, and brincidofovir in the treatment of Monkeypox, especially in vulnerable populations like those living with HIV, is an area of active research 3, 4.
- Studies have indicated that tecovirimat is the most used antiviral for Monkeypox and has proven beneficial in several cases, with no major safety concerns detected upon its use 4.
- The treatment of Monkeypox in patients with HIV disease using tecovirimat has been documented, with cases showing resolution of symptoms after treatment 5.
Research Gaps
- More data on treatment recommendations and efficacy in patients with immunodeficiency due to HIV is needed, highlighting a gap in current research 3.
- Ongoing research is intensified to verify the efficacy and applicability of antivirals like tecovirimat in the context of the current Monkeypox outbreak, especially considering the unique features of this outbreak and the impact on HIV-positive individuals 3, 5.