Most Hospitalized Monkeypox Patients in the U.S. Were H.I.V.-Positive

Nearly all Americans hospitalized for monkeypox infection had weakened immune systems, most often because of H.I.V. infection, the Centers for Disease Control and Prevention reported on Wednesday.

Of 57 hospitalized patients described in the report, 82 percent had H.I.V. More than two-thirds of the patients were Black and nearly one-quarter were homeless, reflecting racial and economic inequities seen in the outbreak overall.

The finding suggests that although most cases of monkeypox are mild, doctors should test patients with suspected cases for H.I.V. as well, and be prepared to offer prompt treatment for both infections.

“Monkeypox and H.I.V. have collided with tragic effects,” Dr. Jonathan Mermin, the C.D.C.’s lead scientist on monkeypox, said in a statement.

All of them had skin rashes, and most also had severe lesions in the mouth, urethra, rectum or vagina. About one in five experienced symptoms in their lungs and eyes, and in four patients the brain and spinal cord were affected.

Four of the 47 patients with H.I.V. were taking drugs to suppress the virus before they were diagnosed with monkeypox. About one in three had a CD4 count — a proxy for the immune system’s strength — of less than 50, indicating severe immunosuppression.

Two of the patients, one of whom had H.I.V., were being treated for cancer; three were solid organ transplant recipients; and three were pregnant. All of these conditions are linked to a weakened immune system.

One third of the patients were admitted to intensive care units. Of the 12 recorded deaths, five were a result of complications from monkeypox infection, six are under investigation and one was determined to be unrelated.

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