People affected by human immunodeficiency virus (HIV), which causes AIDS, did not develop more severe forms of mpox - compared to HIV-negative people - during the multiregional outbreak of this disease that occurred in Spain in 2022. This is one of the main conclusions of an article published in the journal Scientific Reports , which analysed 1,158 confirmed cases of mpox in adult men. The cases were reported between June 2022 and January 2023 in seven autonomous communities. The population sample analysed in the study represents more than half of the cases recorded in Spain during this period.
"Spain was the European country with the highest cumulative incidence of mpox during the outbreak, which makes the results obtained particularly relevant," say researchers from the Faculty of Medicine and Health Sciences of the University of Barcelona: Aina March-Yagüe, first author of the paper; Diana Toledo, adjunct professor of Preventive Medicine and Public Health; and Àngela Domínguez, professor emeritus and member of the CIBER Area for Epidemiology and Public Health (CIBERESP).
The study indicates that 35% of cases corresponded to people with HIV and that, among HIV-negative individuals, approximately 43% were users of pre-exposure prophylaxis (PrEP) for HIV.
"In all the studied groups, most transmissions occurred within sexual networks, especially among men who had sex with other men, confirming the pattern observed internationally during the 2022 outbreak," the research team notes.
From a clinical perspective, people with HIV more frequently presented with fever and skin lesions in non-anogenital and non-oral locations, as well as a higher rate of other types of immunosuppression. However, the progression of the disease was favourable in all groups analysed, with no admissions to intensive care units or deaths, and with low and similar hospitalization rates among people with and without HIV.
The comparative analysis revealed significant differences between people with HIV and those without HIV who used PrEP. Among people who used PrEP, the most common symptoms were fatigue (asthenia), swollen lymph nodes in various parts of the body (generalized lymphadenopathy) and other sexually transmitted infections. In addition, this group showed greater exposure to risky situations, such as attending large events, having sex in recreational settings, and participating in practices such as chemsex, which combines drugs and sexual activity.
For their part, people with HIV more frequently presented skin lesions outside the genital and oral areas, as well as a higher probability of requiring hospitalization, but this did not result in more severe disease.
The authors of the study highlight the need to adapt mpox prevention and control strategies to different risk profiles, integrating the prevention of this infection into sexual health, HIV and PrEP programmes. They also stress the importance of strengthening evidence-based, non-stigmatizing interventions that focus on the social and behavioural determinants of transmission.
The new study is part of the MONKPOX-ESP22 project, an initiative to comprehensively assess the clinical and microbiological impact of the mpox outbreak. It is led by M. Paz Sánchez-Seco and Jesús Oteo, from the Biomedical Research Networking Centre (CIBER). The study has been carried out by researchers from the CIBER areas for Epidemiology and Public Health (CIBERESP) and Infectious Diseases (CIBERINFEC), in collaboration with epidemiological surveillance services and health centres in several autonomous communities.
Reference article:
March-Yagüe A. et al. "Mpox in people living with and without HIV, including people on PrEP, during a multistate outbreak in Spain in 2022" . Scientific Reports, February 2026. DOI: 10.1038/s41598-026-37209-3.
