Indian J Sex Transm Dis Indian J Sex Transm Dis
Official Publication of the Indian Association for the Study of Sexually Transmitted Diseases
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  Table of Contents  
Year : 2022  |  Volume : 43  |  Issue : 2  |  Page : 219-220

AIDS and monkeypox: Cooccurrence and clinical concern on immunodeficiency

1 Private Academic Consultant, Bangkok, Thailand
2 Department of Biological Science, Joseph Ayo Baalola University, Ikeji-Arakeji, Nigeria; Department of Biological Science, Dr. D. Y. Patil University, Pune, Maharashtra, India; Department of Biological Science, Faculty of Medicine, University of Nis, Nis, Serbia

Date of Submission19-Jun-2021
Date of Decision21-Jun-2022
Date of Acceptance23-Jun-2022
Date of Web Publication17-Nov-2022

Correspondence Address:
Dr. Pathum Sookaromdee
Private Academic Consultant, Bangkok
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijstd.ijstd_60_22

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How to cite this article:
Sookaromdee P, Wiwanitkit V. AIDS and monkeypox: Cooccurrence and clinical concern on immunodeficiency. Indian J Sex Transm Dis 2022;43:219-20

How to cite this URL:
Sookaromdee P, Wiwanitkit V. AIDS and monkeypox: Cooccurrence and clinical concern on immunodeficiency. Indian J Sex Transm Dis [serial online] 2022 [cited 2023 Jun 6];43:219-20. Available from:


Monkeypox has spread over Europe, posing a serious public health threat.[1] This infection is a very unusual pox infection that has resurfaced, most likely due to zoonosis.[2] Monkeypox has become a major public health concern in Europe, North America, and Asia.[1] Monkeypox is a rare type of pox that has resurfaced, most likely as a result of zoonosis. Human-to-human transmission, including sexual intercourse, is under investigation. As the number of recorded cases in various nations rises, the medical community is alarmed, and cautious planning to deal with a possible broad monkeypox outbreak is essential. Monkeypox has historically been endemic throughout western Africa, particularly Nigeria. In the same region, HIV is a major public health concern. However, there has never been a simultaneous report of coinfection or outbreak on this site. The current outbreak in Europe and America, on the other hand, is having the opposite effect. In some cases of monkeypox, up to 25% of the cases tested positive for HIV.[3] In addition, the presence of secondary syphilis infection was verified.[4]

The topic of whether HIV patients with a low CD4+ count are susceptible to monkeypox is a basic one. It is important to know that the monkeypox virus is very infectious and can infect persons with normal immune systems. Monkeypox developed in HIV patients with a suppressed viral load and a normal CD4 count, according to a recent report.[5] According to these findings, the cooccurrence of HIV and monkeypox in the current epidemic in Europe and America may not be explained by HIV cases' immunodeficiency. Another factor could be anal sexual intercourse, which is common among homosexual male HIV patients and increases the chance of developing an infected skin lesion in a hidden area like the genital or perianal areas. Finally, it is unclear if the currently available smallpox vaccination can be used to provide cross-protection against monkeypox in HIV-positive individuals. The production of cross IgG antibodies against the monkeypox virus fails in an animal model if the CD4 count is less than 300.[6]

Finally, it should be noted that although there is a report on coinfection between HIV and monkeypox among males who have sex with males (MSM), the disease is still not concluded as a sexually transmitted disease. The WHO says that the circumstantial evidence suggests the possibility of a sexual mode of transmission, but the initial cases (2021) of monkeypox in Europe are related to travelers from Nigeria, an endemic zone, not a sexual mode. In May 2022, the cases reported in the UK are among MSM. The clinical and epidemic investigation is going on to understand the mode of acquisition as none of these patients had a travel history. In the absence of correct information, the WHO recommends a public health approach that creates awareness and follows time-tested preventive measures. The study of the interrelationship between monkeypox and HIV is an important research topic for closing the monkeypox knowledge gap.

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   References Top

Wiwanitkit S, Wiwanitkit V. Atypical zoonotic pox: Acute merging illness that can be easily forgotten. J Acute Dis 2018;7:88-9.  Back to cited text no. 1
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Mungmunpuntipantip V, Wiwanitkit V. Re-emerging monkeypox: An old disease to be monitored. BMJ Rapid Response. Available from: 1. [Last accessed on 2022 May 21].  Back to cited text no. 2
Bragazzi NL, Kong JD, Mahroum N, Tsigalou C, Khamisy-Farah R, Converti M, et al. Epidemiological trends and clinical features of the ongoing monkeypox epidemic: A preliminary pooled data analysis and literature review. J Med Virol 2022. [doi: 10.1002/jmv. 27931].  Back to cited text no. 3
Bížová B, Veselý D, Trojánek M, Rob F. Coinfection of syphilis and monkeypox in HIV positive man in Prague, Czech Republic. Travel Med Infect Dis 2022;49:102368.  Back to cited text no. 4
Hammerschlag Y, MacLeod G, Papadakis G, Adan Sanchez A, Druce J, Taiaroa G, et al. Monkeypox infection presenting as genital rash, Australia, May 2022. Euro Surveill 2022;27. [doi: 10.2807/1560-7917.ES.2022.27.22.2200411].  Back to cited text no. 5
Smith YE, Bray M, Whitehouse CA, Miller D, Mucker E, Manischewitz J, et al. Smallpox vaccine does not protect macaques with AIDS from a lethal monkeypox virus challenge. J Infect Dis 2005;191:372-81.  Back to cited text no. 6


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