The resurgence of mpox, formerly known as monkeypox, continues to pose a public health challenge, particularly for men who have sex with men (MSM) living with HIV. New research from Hangzhou, China, underscores a concerning trend: mpox-HIV coinfection is associated with more severe illness and a significantly higher risk of hospitalization. The findings, published February 19, 2026, in AIDS Behavior, highlight the critical need for integrated prevention and surveillance strategies targeting these vulnerable populations.
The study, a retrospective analysis of 104 confirmed mpox cases in Hangzhou, compared individuals with mpox and HIV coinfection to those with mpox alone. Researchers also included a matched group of individuals with HIV monoinfection to better understand the factors contributing to more severe outcomes in those with both infections. This detailed look at mpox-HIV coinfection provides valuable insights into the interplay between these viruses and the importance of considering immune status when evaluating and treating mpox.
Greater Symptom Burden and Hospitalization Risk
The analysis revealed a clear difference in symptom severity between the two groups. Patients with mpox-HIV coinfection reported significantly more lesion pain – 67.39% compared to 39.66% in those with mpox monoinfection. More strikingly, all 27 hospitalizations within the study cohort occurred among individuals with mpox-HIV coinfection, including one admission to the intensive care unit. This data strongly suggests that the presence of HIV significantly increases the risk of severe mpox requiring hospitalization.
Immune Suppression and Behavioral Factors
Even as the vast majority (97.83%) of coinfected patients were receiving antiretroviral therapy (ART) for HIV, a substantial proportion – 28.26% – had CD4+ T-cell counts at or below 350 cells per microliter. CD4+ T-cells are crucial components of the immune system, and lower counts indicate immune suppression, making individuals more vulnerable to opportunistic infections like mpox. The study found a direct correlation between lower CD4 counts and more severe clinical manifestations, as well as increased hospitalization rates. This finding reinforces the importance of monitoring CD4 counts in individuals with HIV who contract mpox.
Beyond immune status, the researchers identified behavioral factors associated with mpox-HIV coinfection. High-risk sexual behaviors, including having multiple sexual partners and frequent sexual activity, were more common among those with both infections. These patterns suggest that targeted prevention efforts focusing on safer sex practices are crucial for reducing the spread of both viruses within high-risk groups. A separate analysis of mpox cases in Zhejiang Province from June 2023 to December 2024, published in PubMed, showed that nearly 40% of mpox cases were co-infected with HIV, all among MSM, with a higher rate of coinfection observed in 2023 compared to 2024.
Implications for Clinical Practice
For healthcare providers in the United States and elsewhere, these findings emphasize the need to consider HIV status when evaluating patients presenting with suspected mpox. Documenting a patient’s HIV status and recent CD4+ T-cell count can help clinicians assess their risk for severe illness and guide treatment decisions. Careful assessment of lesion pain and distribution is also important, as these symptoms appear to be more pronounced in coinfected individuals. While mpox is often self-limiting, the study underscores that coexisting immunocompromise can significantly alter the disease course.
The authors advocate for coordinated public health strategies that address both HIV and mpox in populations experiencing overlapping risk factors. This includes expanding access to HIV testing and treatment, promoting safer sex practices, and ensuring that individuals with HIV have access to timely mpox vaccination. The European Medical Journal recently reported on the increased hospitalization rates associated with mpox-HIV coinfection, further emphasizing the global significance of this issue. Mpox-HIV Coinfection Tied to Higher Hospitalization
As public health officials continue to monitor the evolving mpox situation, understanding the factors that contribute to severe illness – particularly in vulnerable populations – is paramount. Further research is needed to determine the optimal strategies for preventing and treating mpox-HIV coinfection and mitigating its impact on public health.
Disclaimer: This article provides information for general knowledge and informational purposes only, and does not constitute medical advice. It is essential to consult with a qualified healthcare professional for any health concerns or before making any decisions related to your health or treatment.
Stay informed about mpox and HIV prevention efforts through the Centers for Disease Control and Prevention (https://www.cdc.gov/) and your local health department. We encourage readers to share this information and engage in respectful dialogue about these important public health issues.
