HIV and Human Mpox Coinfection in Jos, Nigeria: A Case Series.

Background: Mpox has been reported among people living with HIV (PLHIV) in Nigeria. Objectives: This case series highlights the potential impacts of immune status, occupational exposure, and (Highly active anti-retroviral therapy (HAART) adherence disparities on Mpox progression. Method: A case series study of HIV patients with Mpox features who presented to the Infectious Disease Unit of a tertiary Hospital, Jos, Nigeria in 2022. Results: Two Patients were included. Case 1 involved a 27-year-old dental health worker with a week-long painful, pruritic, papular, vesiculopustular rash on her body appearing three days after a high-grade fever. Diagnosed with Human immunodeficiency virus (HIV) five months prior, she was adherent to HAART. Her CD4 count was 120 cells/µL. Case 2 was a 32-year-old sex worker with similar symptoms but with more florid pruritic lesions, which was ineffectively treated. Diagnosed with HIV four months prior, she declined HAART. Her CD4 count was 69 cells/µL. PCR testing confirmed Mpox in both patients. Both patients showed clinical improvement with conservative management and adherence counseling for Case 2, who subsequently commenced HAART. For Case 1, hospitalization lasted 13 days while Case 2 had a prolonged hospitalization of 65 days, likely due to delayed presentation, and advanced Mpox progression exacerbated by untreated HIV and reduced immunity. Her multiple casual sex partners and mobility may also have heightened her risk of Mpox transmission and progression. Conclusion: These cases suggest that lower CD4 counts and poor immune status can extend Mpox recovery, underscoring the importance of timely HIV treatment and a One Health approach to address occupational risks and promote HAART adherence.