First HIV, Monkeypox, SARS-CoV-2 Coinfection Confirmed

A new Letter presented the clinical features and diagnostic procedure of the first documented case of co-infection with monkeypox virus, SARS-CoV-2, and HIV-1 in an Italian 36-year-old male.

Published on August 19, 2022, by the peer-review Journal of Infection, this case highlights how monkeypox disease and COVID-19 symptoms may overlap and corroborates how in case of co-infection, anamnestic collection and sexual habits are crucial to perform the correct diagnosis.

In fact, the patient tested positive for HIV-1 with a viral load of 234,000 copies/mL, and given his preserved CD4 count, which was unaltered with 812 cells/μL, it could be assumed that the infection was relatively recent.

However, as this is the only reported case of monkeypox virus, SARS-CoV-2 coronavirus, and HIV co-infection, there is still not enough evidence supporting that this combination may aggravate a patient's condition.

Given the current SARS-CoV-2 pandemic and the daily increase of monkeypox cases, healthcare systems must be aware of this eventuality, promoting appropriate diagnostic tests in high-risk subjects, which are essential to containment as there is no widely available treatment or prevention, wrote Santi Nolasco, MD, Department of Clinical and Experimental Medicine, University of Catania and colleagues. 

To note, the monkeypox oropharyngeal swab was still positive after twenty days, suggesting that these individuals may still be contagious for MPXV several days after clinical remission.

Consequently, physicians should encourage appropriate precautions.

And clinicians should be aware of the possibility of SARS-CoV-2 and MPXV co-infection, particularly in subjects with a recent history of travel to monkeypox-outbreak areas.

If monkeypox is suspected, an oropharyngeal swab should be performed even without cutaneous manifestations as the skin may be spared, but the oral or rectal mucosa may be involved.

These study authors have no industry conflicts of interest to declare, and this study had no outside funding.

The full Research Letter is posted at this link.

In a previous report published on June 2, 2022, four cases in Italy detected MPX DNA in semen, feces, and saliva.

The good news is there are MPXV and COVID-19 vaccines approved by the U.S. FDA.

Unfortunately, HIV vaccine candidates remain unauthorized as of August 21, 2022.

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