Man tests positive for monkeypox, COVID-19 and HIV in ‘world first’ case

A man receives a monkeypox vaccine

Scientists have reported that a man has tested positive for monkeypox, COVID-19, and HIV simultaneously in the first known case of its kind.

The Italian man is said to have developed a series of symptoms a week after returning from a trip to Spain, including fatigue, fever, and a sore throat, according to a case study from the University of Catania.

He initially tested positive for COVID-19 on 2 July but referred himself to a hospital in Palermo a few days later after noticing a rash on his torso, face, and legs as well as painful blisters dotted around his body.

Doctors tested him for monkeypox, which also returned as positive.

The case “highlights how monkeypox and COVID-19 symptoms may overlap”, according to the report.

It added: “Given the current [COVID-19] pandemic and the daily increase of monkeypox cases, healthcare systems must be aware of this eventuality.”

After running further tests, doctors also determined that the man was also living with HIV.

The report added: “As this is the only reported case of monkeypox virus, SARS-CoV-2 [COVID-19], and HIV co-infection, there is still not enough evidence supporting that this combination may aggravate [the] patient’s condition”.

While there is limited evidence on how HIV can impact monkeypox acquisition or illness, the World Health Organization has said “those who take antiretrovirals and have a robust immune system have not reported a more severe course”.

Dr Claire Dewsnap, president of the British Association for Sexual Health and HIV, told an aidsmap event that people living with HIV with viral suppression on effective therapy, and a CD4 count above 200, “are not at any particular risk of becoming significantly more unwell”.

A CD4 count refers to the number of blood cells in a cubic millimetre of blood. Typically a lowered CD4 level is a sign of HIV infection due to the disease damaging white blood cells.

The patient’s preserved CD4 count indicated the he had recently acquired HIV, the report said.

The individual was eventually discharged from hospital on 11 July and was ordered to continue home isolation despite no longer displaying symptoms.

“The monkeypox swab was still positive after 20 days, suggesting that these individuals may still be contagious for several days after clinical remission,” the study continued.

“Consequently, physicians should encourage appropriate precautions.”

Spain currently has the second most monkeypox cases in the world according to data from the Centers for Disease Control and Prevention (CDC), with more than 6,200 confirmed cases and two deaths, at the time of reporting.

The two monkeypox-related deaths were announced by health officials in the country in July and are believed to be the first in Europe. The first patient, in Valencia, suffered from encephalitis – an inflammation of the brain associated with monkeypox – and died on 29 July. The second death came just a day after on 30 July.

The only country ahead of Spain for monkeypox cases is the United States, with more than 16,602 cases reported since 24 August, 2022. Of these, 99 per cent have been among men who have sex with men, according to a 25 July report from the Centre of Preparedness and Response. This has caused several anti-LGBTQ+ groups to falsely call it a “gay disease“.