On July 23, 2022, the World Health Organization declared monkeypox a global health emergency. In the current outbreak, the first person with a confirmed case of monkeypox in the United States was identified in May. This serious emerging outbreak is more common among men who have sex with men than the general population, but also has occurred in women and children. Some reports suggest that monkeypox could be an opportunistic infection in people with HIV, who at present account for about 40% of cases.
A U.S. Food and Drug Administration–approved live attenuated, non-replicating virus vaccine that contains modified vaccinia Ankara (produced by Bavarian-Nordic and sold as JYNNEOS in the United States) currently is available for people at increased risk of exposure. Further information can be found on the Centers for Disease Control and Prevention’s (CDC) Vaccination Strategies webpage.
Vaccination with JYNNEOS is considered safe for people with HIV. Recommendations on vaccine eligibility and administration can be found on the CDC’s Monkeypox Vaccine Information for Healthcare Professionals webpage.
Recommendations for assessing infection risk after exposure and the need for post-exposure prophylaxis can be found on the CDC’s Monitoring and Risk Assessment for Persons Exposed in the Community webpage.
Antiviral treatments, including tecovirimat (TPOXX), are available to treat people diagnosed with monkeypox virus infection. Recommendations on the use of TPOXX can be found on the CDC’s Guidance for Tecovirimat Use Under Expanded Access Investigational New Drug Protocol During the 2022 U.S. Monkeypox Outbreak webpage. At present, this drug is available only through an expanded-use investigational drug protocol. Instructions for obtaining this drug can be found on the CDC’s Information for Healthcare Providers on Obtaining and Using TPOXX (Tecovirimat) for Treatment of Monkeypox webpage.
Individuals taking antiretrovirals and other medications may require drug dosing adjustments with concomitant TPOXX administration. More information can be found on the Adult and Adolescent Antiretroviral Guidelines, Table 24b: Drug Interactions Between Non-Nucleoside Reverse Transcriptase Inhibitors and Other Drugs webpage.
Currently, the best information about the clinical management of monkeypox can be found on the CDC’s Clinical Considerations for Treatment and Prophylaxis of Monkeypox Virus Infection in People with HIV webpage and in the Infectious Diseases Society of America and HIV Medicine Association publication Monkeypox in the U.S.: Resources for HIV Clinicians.