Top 5 Takeaways

1. Enhanced Risk for Persons with HIV: Persons with advanced HIV infection, especially those not virologically suppressed with antiretroviral therapy (ART), may face increased risk for severe monkeypox disease.
2. Guidance on Vaccination: JYNNEOS vaccine, recommended for persons with HIV, is deemed safe and effective for pre- and postexposure prophylaxis against monkeypox, without the risk of severe adverse effects associated with ACAM2000 in immunocompromised individuals.
3. Tecovirimat as a First-Line Treatment: Tecovirimat, with no identified drug interactions that would preclude coadministration with ART, is the recommended first-line medication for treating monkeypox among persons with HIV infection.
4. Prevention and Postexposure Prophylaxis: Postexposure vaccination with JYNNEOS within 4 days of exposure may prevent monkeypox, and vaccination between 5–14 days after exposure might reduce the severity of the disease if infection occurs.
5. Continuous Monitoring and Updating of Guidelines: The CDC will update prevention and treatment considerations as more information becomes available, acknowledging the current limitations in data regarding monkeypox in persons with HIV.

Note:

This MMWR Article was created prior to the conventional renaming of Monkeypox to its more standard and appropriate name, Mpox. To avoid confusion, Monkeypox is retained when writing this article, but all future works should use Mpox.

Original Article Author and Citation

Corresponding Author

Jesse O’Shea, kst4@cdc.gov.

Suggested Citation

O’Shea J, Filardo TD, Morris SB, Weiser J, Petersen B, Brooks JT. Interim Guidance for Prevention and Treatment of Monkeypox in Persons with HIV Infection — United States, August 2022. MMWR Morb Mortal Wkly Rep 2022;71:1023-1028. DOI: http://dx.doi.org/10.15585/mmwr.mm7132e4.

Summary

The CDC has developed clinical considerations for the prevention and treatment of monkeypox in persons with HIV infection. These include pre-exposure and postexposure prophylaxis with JYNNEOS vaccine, treatment with tecovirimat, and infection control measures. Advanced HIV infection may increase the risk for severe monkeypox, but prompt diagnosis, treatment, and enhanced prevention efforts can mitigate this risk.

Methods

The guidance is based on a review of available evidence, including the safety and efficacy of vaccines and treatments, transmission patterns, and the clinical manifestations of monkeypox. It also considers the potential drug interactions between tecovirimat and antiretroviral therapy (ART) for HIV infection.

Discussion

Persons with HIV are disproportionately represented among monkeypox cases, and those with advanced and uncontrolled HIV infection may face higher risks for severe or prolonged disease. The guidance emphasizes the importance of continuing ART and opportunistic infection prophylaxis in persons with HIV who acquire monkeypox. Vaccination with JYNNEOS is highlighted as a key preventive measure, and tecovirimat is recommended as the first-line treatment.

Conclusion

The CDC’s interim guidance addresses the urgent need for clear prevention and treatment strategies for monkeypox in persons with HIV infection. By considering the specific risks and treatment interactions for this population, the guidance aims to reduce the risk of severe outcomes and limit the spread of monkeypox.

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