High prevalence and non-suppression of HIV/AIDS in the East and Central African region heightens risk of severe outcomes for Clade I monkeypox virus infection, and may be a driver for subsequent adaptation

Abstract

In September 2023, a re-emergence of mpox was noted in the province of South Kivu, in DR Congo. So far, active transmission has been reported in 23 of the 26 provinces. Despite localisation within DRC, there are emerging concerns about possibility of cross-border transmission. In this perspective, we highlight the threat posed to HIV positive patients, particularly those with unsuppressed viral loads. We make several prepositions as part of the preparedness and response plans in the countries in the East and Central Africa region. The six prepositions include: 1) operationalize the Joint Africa Task Force for mpox consistent with Kinshasa declaration on mpox, 2) increased surveillance, 3) deployment of point of care diagnostics, 4) targeted reactive vaccination and enhanced antiretroviral therapy of HIV positive patients in areas of active transmission, 5) community engagement, 6) foster capacity building of national rapid response teams in East and Central Africa in mpox care and management through collaboration with DRC counterparts. HIGHLIGHTS • The ongoing mpox outbreak in regions with a high HIV prevalence is a concern. • In the region, only 90 % of the people with HIV have viral suppression. • Commercial sexual activity is one of the biggest drivers of HIV in this region. • In DRC, up to 29 % of the mpox cases are female sex workers. • There is an imminent danger of double-edged health challenges of mpox and HIV.