Nail Disorders in Patients Living with HIV Coinfected with Monkeypox

Dear Editor, This article aims to shed light on the link between human immunodeficiency virus (HIV), mpox coinfection, and nail changes, a frequently ignored feature of HIV-related comorbidities. In a recent publication, the large prevalence of nail involvement in individuals with both disorders, as well as the link between CD4 count and the occurrence of nail diseases, was emphasized. However, while the study design is methodologically solid, there are certain constraints to consider.[1] However, that study’s cross-sectional design makes it difficult to draw causal conclusions between HIV, mpox, and nail changes. Longitudinal studies would be more successful at observing changes over time and understanding how these circumstances evolve, especially in relation to oscillations in the CD4 count and viral load.[1] Indeed, nail presentation such as onychodystrophy is possible but less mentioned in monkeypox.[2] It is important to provide a complete picture of the broader population living with HIV and coinfected with mpox, especially as the study did not consider a variety of characteristics such as age, gender, or geographic location. Regarding the unknown issues, it is unclear if these findings would hold true in a larger, more diverse cohort. Furthermore, it should account for other potential confounders, such as antiretroviral medication (ART), which may affect both viral load and immune function, hence influencing the presence of nail changes. The study’s findings, such as the link between lower CD4 counts and more severe nail manifestations like splinter hemorrhages, onychomadesis, and acute paronychia, suggest that nail involvement could be a useful clinical marker for monitoring HIV progression, especially in coinfected patients. However, this raises broader questions concerning the pathophysiology behind these nail modifications.[1] Are these changes caused simply by immune system decline, or do other factors, such as mpox coinfection, play a role? Future research should look into the molecular mechanisms that link viral coinfections to nail changes, such as how mpox and other opportunistic infections increase the occurrence of nail abnormalities in immunocompromised patients. Looking ahead, the findings highlight several areas for future investigation. Future research should also focus on the long-term effects of mpox on nail health in HIV patients and potential interventions to manage or prevent nail changes. Furthermore, a bigger, multicenter prospective cohort study could better catch varied groups and provide more reliable results. Furthermore, examining the function of various ARTs or mpox treatments in determining nail disease severity would be a worthwhile endeavor. Finally, including qualitative research methodologies, such as patient interviews, could provide more in-depth insights into people’s lived experiences with these problems, as well as their perspectives on the importance of nail health in HIV care. Author contributions HP: 50% ideas, writing, analyzing, and approval. VW: 50% ideas, supervision and approval. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest