The United States has been experiencing a monkeypox (MPV) outbreak since late May 2022. While the number of cases is decreasing, it is still important to be aware of MPV symptoms, treatment, and how they impact people living with HIV. Especially since in the United States and Europe, it is estimated that 28-51% of cases are among people living with HIV. While it is true that many cases have been among men who have sex with men, MPV is nonetheless spread through close contact- including non-sexual contact.
Most commonly, MPV first presents as a fever and swollen lymph nodes, followed by a rash 1-3 days later. The incubation period of MPV (in other words, the amount of time it takes after someone is exposed to MPV to experience these symptoms and or test positive for MPV) is 3-17 days. There is admittedly much we do not know about MPV and HIV: for example, whether or not the timelines above are the same for people living with HIV. At the same time, people living with HIV who are taking antiretrovirals and thus have a more robust immune system do not appear to experience more severe MPV. Nonetheless, the limited information we do have suggests that people living with HIV who are not virally suppressed may possibly be at higher risk of more severe and or longer lasting MPV infection. Additionally, these individuals who contract MPV may develop a rash that appears different from what is expected, is more spread out across the body, or are more likely to develop genital lesions. If you develop a rash, please do not hesitate to see your doctor and request a comprehensive examination plus laboratory testing.
Fortunately, there are treatment options available for people who contract MPV, people who have close contact with someone who has tested positive for MPV, and people who want to take precautions against contracting MPV. Those who aim to prevent MPV may consider the JYENNOS vaccine, which is safe for people living with HIV. However, it is unknown whether those with lower CD4 counts or who are not virally suppressed will experience the same level of immune response. Additionally, it is important to know that that exposure to MPV within 2 weeks of receiving an initial dose of the vaccine may still lead to infection.
If someone has been exposed to MPV, the CDC recommends vaccination within 4 days. However, when given within 4-14 days of exposure, the vaccine may still reduce MPV severity. An MPV vaccine locator is available here, though due to limited supply, many sites have specific eligibility requirements. At the same time, the CDC recently recommended that people living with HIV be prioritized in distribution of the JYENNOS vaccine. The vaccine is usually offered at no cost to you. While the ACAM2000 vaccine is also available at some sites, this vaccine is not recommended for people living with HIV due the risk of adverse effects. It is also recommended that people living without HIV do not get this vaccine if they live with or otherwise spend much time around someone(s) living with HIV and temporary isolation at home would be difficult.
Several antivirals are available to treat MPV in pill, injection, and IV infusion form. They may also be considered for people who have been exposed to MPV on a case-by-case basis, yet it is unclear whether they are effective in these circumstances. Most people experience only minor side effects. However, since some people living with HIV may need to temporarily change their antiretroviral regimen, it is important to check in with the medical professional(s) treating you for MPV. While other drug-drug interactions are uncommon when taking these antivirals, it is still important to mention which additional medications you are currently taking.
In addition to avoiding close contact with someone who has been exposed to or has tested positive for MPV, the CDC recommends avoiding contact with items and surfaces used by someone with MPV. Lastly, people with MPV should isolate until all scabs on their skin have fallen off and been replaced with a new layer of skin, since MPV is contagious until this process is complete.
Source: Centers for Disease Control and Prevention. (2022, August 17). Clinical considerations for treatment and prophylaxis of monkeypox virus infection in people with HIV. Centers for Disease Control and Prevention. Retrieved September 30, 2022, from https://www.cdc.gov/poxvirus/monkeypox/clinicians/people-with-HIV.html