Monkeypox in HIV Infected Cases: A Summary on Clinical Presentation of 27 Cases

Dear Editor:

Monkeypox emerges as a fresh public health threat in 2022. Acute febrile sickness and vesicular skin problems are the disease's hallmarks [1]. For a very long time, monkeypox has existed throughout Africa. This area has also been impacted by the human immunodeficiency virus (HIV) problem for a long time. It's an interesting discovery that the two diseases coexist. The co-occurrence has been documented in various places. A fascinating scientific topic is the potential coexistence of HIV and monkeypox. Here, the authors conducted a retrospective study with the goal of providing a summary of the data on the clinical manifestation of monkeypox in patients with HIV infection. A basic literature search was conducted using the international database PubMED. The words "HIV" and "monkeypox" were important. We searched for papers using the keywords "HIV" and "monkeypox" to discover more information. Retrospective analysis is done on the clinical presentation specifics in published instances. Any reports written in English are included, whereas ones lacking the necessary data are omitted. There are a total of 27 cases of concurrent monkeypox and HIV infection, according to the search [2,3,4,5,6] (Table 1). Of the patients, 24 are men (88.9%). They were all older than thirty. One instance has a history of receiving a smallpox immunization in the past. One syphilis case among all HIV positive cases has been observed (3.7%). All instances tested negative for Hbs antigen HCV antibodies. While hemoglobin and the white blood cell count/differential were within normal limits, 11.1% of patients had thrombocytopenia. Averaging 280.1 + 207.3 cells/mm³, the CD4+ count varied from 20 to 700 cells/mm³. Every antiretroviral medication regimen is the same. The vesicular cutaneous lesion is the primary complaint in each instance. Over 100 skin lesions connected to genital ulcers were present in all HIV-positive individuals. Two cases (7.4%; all had CD4+ counts below 100 cells/mm³) were fatal.

Table 1. Summarization of recent monkeypox cases in HIV patients.

Reports	Sumamrization
Bížová et al. [2]	This is a case study of an HIV seropositive man who had both syphilis and monkeypox at the same time. The patient has an unusual skin lesion near the genitalia. The patient fully recovered with no complications.
Hammerschlag et al. [3]	This is a case report of HIV seropositive man with monkeypox. The patient present with painful pruitic skin lesion at penis. The patient fully recovered with no complications.
Ogoina et al. [4]	There are 2 cases of HIV seropositive patient among the monkeypox cases in this report. The patient presented with chickenpox like lesion. The patients fully recovered with no complications.
Ogoina et al. [5]	The 9 cases of monkeypox that tested positive for HIV were described in the present studies. Clinical characteristics are contrasted with non-HIV cases in the report. There are 2 death cases.
Perez Duque et al. [6]	In this study, there are 14 instances of monkeypox that are also HIV positive. The most common complaints are genital or anal vesicular lesions. The patients fully recovered with no complications.

HIV, human immunodeficiency virus.

This article claims that monkeypox can infect HIV-positive individuals independent of CD4+ count, and that the clinical presentation is typically a big skin lesion at the genital area. Syphilis coinfection is conceivable. If the patient's CD4+ count is extremely low, death may occur. In case that CD4+ count is normal, the clinical features of the patients is similar to those non-HIV infected cases. In HIV patients, some clinical characteristics of monkeypox might be different from non-those in non-HIV patients. In non-HIV infected cases, the patients usually present with febrile illness and generalized skin rash [1]. For the HIV infected cases, there might be the hidden skin lesion at only genital or perinatal areas. The first clinical presentation might be only skin vesicles and there might be no chief complaint of fever. The death rate among non-HIV infected individuals in the endemic region, the western part of Africa, is approximately 3.6% [7] when considering the clinical course. The observed mortality rate among the HIV-infected cases identified in this study is higher, and those who have a low CD4+ count run a high chance of developing the severe disease. In light of the aforementioned characteristics of monkeypox in HIV-infected patients, treatment of the patients must be cautious. Any HIV-positive person presenting with a genital or anorectal lesion should have monkeypox on their differential diagnosis list. Additionally, individuals with low CD4+ counts who have the monkey pox infection and HIV should receive comprehensive clinical supportive treatment.