WHO Urges Swift Treatment for HIV, Mpox Patients

In the latest update of the clinical management and infection prevention control of mpox guidelines (May 2025) WHO has issued a strong recommendation for the rapid initiation of antiretroviral therapy (ART) in people living with HIV who are diagnosed with mpox.

Mpox disproportionally affects people living with HIV. The infection is more severe with higher rates of mortality and hospitalization in people with advanced HIV disease .

This recommendation aligns with WHO's broader HIV treatment guidance that strongly recommends rapid ART initiation – ideally within seven days of HIV diagnosis, including same-day start – to reduce mortality and achieve viral suppression. While concerns about mpox immune reconstitution inflammatory syndrome (IRIS) exist, WHO experts concluded that the benefits of rapid ART initiation outweigh potential risks, especially given the lack of effective mpox-specific treatments.

The guideline also emphasizes the importance of early HIV testing for all patients presenting with suspected or confirmed mpox. For individuals already on ART with a suppressed viral load, treatment should continue without interruption.

"We now know people with HIV, particularly those with a CD4 count under 200 cells/mm³, are at risk for severe disease and death from mpox," said Dr Meg Doherty, Director of WHO's Global HIV, Hepatitis and STI Programmes. "Ensuring early access to HIV and syphilis testing and treatment to all people with confirmed or suspected mpox, as well as timely access to mpox vaccines and antivirals, will save lives".

This recommendation reflects WHO's commitment to integrated care and highlights the importance of timely HIV diagnosis and treatment in mitigating severe outcomes in co-infected patients. To strengthen implementation of early testing, WHO has published standard operating procedures for integrated testing, including HIV and syphilis, as part of the mpox response.

WHO's diagnostic and treatment guidance provide essential information and tools to optimize health outcomes.

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