About
Bradford		   HIV/AIDS
Articles		   Alternative
Therapies		   HIV/AIDS
Videos		   HIV/AIDS
Links		   HIV/AIDS
News

Introduction:
Positively Positive
- Living with HIV		   Out
About
HIV		   Resume/
Curriculum Vitae:
HIV / AIDS Involvements		   Biography   HIV/AIDS
News Archive
HIV/AIDS News spacer.gif spacer.gif
spacer.gif
   
AIDS Awareness Red Ribbon

    Mpox in people living with and without HIV, including people on PrEP, during a multistate outbreak in Spain in 2022

    Scientific Reports , Article number:   (2026) Cite this article

    We are providing an unedited version of this manuscript to give early access to its findings. Before final publication, the manuscript will undergo further editing. Please note there may be errors present which affect the content, and all legal disclaimers apply.

    Abstract

    Spain reported the highest cumulative incidence of mpox in Europe during the 2022 outbreak, which disproportionately affected people living with HIV (PLWH) and HIV-negative individuals using pre-exposure prophylaxis (PrEP). We conducted a multicentre cross-sectional study to analyze epidemiological, clinical, and disease progression characteristics of mpox among PLWH, HIV-negative individuals, and PrEP user cases and non-user cases in Spain. Data were collected from June 2022 to January 2023, including 1,158 men aged ≥ 18 years; 35.3% were PLWH and 42.7% of HIV-negative individuals were PrEP users. Adjusted OR and the 95% CI were calculated by multivariate logistic regression analysis. More frequently PLWH than HIV-negative cases were having sex only with men (aOR = 10.92;3.76–31.69), chemsex (aOR = 2.02;1.38–2.97), another type of immunosuppression (aOR = 2.57;1.07–6.21) and non-anogenital and non-oral exanthems (aOR = 1.64;1.23–2.19). More frequent in PLWH compared to PrEP user cases were lower education levels (aOR = 23.21;2.87–187.52), fever (aOR = 1.42;0.98–2.06), non-anogenital and non-oral exanthems (aOR = 2.40;1.67–3.45) and another type of immunosuppression (aOR = 9.32;1.16–75.16) and more frequent in PrEP user cases than in non-PrEP user cases were risk factors related to sexual activity and concurrent sexually transmitted infections. PLWH did not experience more severe mpox than HIV-negative persons. These findings underscore the need for tailored prevention and clinical approaches.

    Data availability

    The data underlying this article will be shared on reasonable request to the corresponding author.

    References

    1. International Committee on Taxonomy of Viruses. Taxon details. https://ictv.global/taxonomy/taxondetails?taxnode_id=202204771&taxon_name=Monkeypox%20virus. Accessed 28 Apr 2024 (2022).

    2. Huang, Y., Mu, L. & Wang, W. Monkeypox: Epidemiology, pathogenesis, treatment and prevention. Signal Transduct Target Ther. 7, 373. https://doi.org/10.1038/s41392-022-01215-4 (2022).

      Google Scholar 

    3. Isidro, J. et al. Phylogenomic characterization and signs of microevolution in the 2022 multi-country outbreak of Monkeypox virus. Nat. Med. 28, 1569–1572. https://doi.org/10.1038/s41591-022-01907-y (2022).

      Google Scholar 

    4. World Health Organization. Mpox: key facts. https://www.who.int/news-room/fact-sheets/detail/mpox. Accessed 28 Apr 2024. (2024).

    5. Centers for Disease Control and Prevention. How mpox spreads. https://www.cdc.gov/mpox/causes/index.html. Accessed 16 Feb 2025 (2025).

    6. Mitjà, O. et al. Monkeypox. Lancet 401, 60–74. https://doi.org/10.1016/S0140-6736(22)02075-X (2023).

      Google Scholar 

    7. Petersen, E. et al. Human monkeypox: Epidemiologic and clinical characteristics, diagnosis, and prevention. Infect. Dis. Clin. N. Am. 33, 1027–1043. https://doi.org/10.1016/j.idc.2019.03.001 (2019).

      Google Scholar 

    8. World Health Organization. WHO Director-General’s statement at the press conference following IHR Emergency Committee regarding the multi-country outbreak of monkeypox—23 July 2022.. https://www.who.int/director-general/speeches/detail/who-director-general-s-statement-on-the-press-conference-following-IHR-emergency-committee-regarding-the-multi--country-outbreak-of-monkeypox--23-july-2022. Accessed 27 May 2024 (2022).

    9. Nuzzo, J. B., Borio, L. L. & Gostin, L. O. The WHO declaration of monkeypox as a global public health emergency. JAMA 328, 615. https://doi.org/10.1001/jama.2022.12513 (2022).

      Google Scholar 

    10. World Health Organization. 2022–23 Mpox (monkeypox) outbreak: Global trends. https://worldhealthorg.shinyapps.io/mpx_global. Accessed 12 Apr 2024 (2023).

    11. Ministerio de Sanidad, Instituto de Salud Carlos III. Protocolo para la detección precoz y manejo de casos ante la alerta de viruela de los monos (monkeypox) en España. (Protocol for early detection and case management in the context of the mpox alert in Spain). https://www.sanidad.gob.es/profesionales/saludPublica/ccayes/alertasActual/alertaMonkeypox/docs/20220610_ProtocoloMPX.pdf. Accessed 27 May 2024 (2022).

    12. Saldana, C. S., Kelley, C. F., Aldred, B. M. & Cantos, V. D. Mpox and HIV: A narrative review. Curr. HIV/AIDS Rep. 20, 261–269. https://doi.org/10.1007/s11904-023-00661-1 (2023).

      Google Scholar 

    13. Mitjà, O. et al. Mpox in people with advanced HIV infection: A global case series. Lancet 401, 939–949. https://doi.org/10.1016/S0140-6736(23)00273-8 (2023).

      Google Scholar 

    14. Thornhill, J. P. et al. Monkeypox virus infection in humans across 16 countries-April-June 2022. N. Engl. J. Med. 387, 679–691. https://doi.org/10.1056/NEJMoa2207323 (2022).

      Google Scholar 

    15. Estévez, S. et al. Epidemiological and clinical characteristics of patients admitted to a secondary hospital with suspected MPOX virus infection: Is HIV playing a role?. J. Clin. Med. 12, 4124. https://doi.org/10.3390/jcm12124124 (2023).

      Google Scholar 

    16. Martínez de Victoria-Carazo, J. et al. Mpox infection and sexually transmitted infections: A cross-sectional study from a secondary hospital in the May–September 2022 international outbreak. AIDS Res. Hum. Retroviruses 39, 604–609. https://doi.org/10.1089/AID.2023.0016 (2023).

    17. Palma, D., et al. A new STI in the city: MPOX in Barcelona. First outbreak (5/2022–5/2023) and subsequent resurgence. PLoS One 20, e0296141. https://doi.org/10.1371/journal.pone.0296141 (2025).

    18. Triana-González, S. et al. Risk factors for mortality and clinical presentation of monkeypox. AIDS 37, 1979–1985. https://doi.org/10.1097/QAD.0000000000003623 (2023).

      Google Scholar 

    19. Pilkington, V. et al. Clinical presentation of mpox in people with and without HIV in the United Kingdom during the 2022 global outbreak. AIDS Res. Hum. Retroviruses 39, 581–586. https://doi.org/10.1089/AID.2023.0014 (2023).

      Google Scholar 

    20. Català, A. et al. Monkeypox outbreak in Spain: Clinical and epidemiological findings in a prospective cross-sectional study of 185 cases. Br. J. Dermatol. 187, 765–572. https://doi.org/10.1111/bjd.21790 (2022).

      Google Scholar 

    21. Tarín-Vicente, E. J. et al. Clinical presentation and virological assessment of confirmed human monkeypox virus cases in Spain: a prospective observational cohort study. Lancet 400, 661–669. https://doi.org/10.1016/S0140-6736(22)01436-2 (2022).

      Google Scholar 

    22. Hoffmann, C. et al. Clinical characteristics of monkeypox virus infections among men with and without HIV: A large outbreak cohort in Germany. HIV Med. 24, 389–397. https://doi.org/10.1111/hiv.13378 (2023).

      Google Scholar 

    23. Furtado Costa, A. et al. Clinical and epidemiological features of mpox in a Brazilian reference center for HIV and sexually transmitted infections: A cross-sectional study. IJID Regions. 10, 114–122. https://doi.org/10.1016/j.ijregi.2023.11.017 (2023).

      Google Scholar 

    24. Kowalski, J., Cielniak, I., Garbacz-Łagożna, E., Cholewińska-Szymańska, G. & Parczewski, M. Comparison of clinical course of mpox among HIV-negative and HIV-positive patients: A 2022 cohort of hospitalized patients in Central Europe. J. Med. Virol. 95, e29172. https://doi.org/10.1002/jmv.29172 (2023).

      Google Scholar 

    25. Del Pozo-Herce, P. et al. Exploration of mental health elements in chemsex behavior: Interventions, influencing factors, and attitudes towards risk and harm reduction in Spain. Nurs. Rep. 14, 2313–2326. https://doi.org/10.3390/nursrep14030172 (2024).

      Google Scholar 

    26. Ramírez-Soto, M. C. & Arroyo-Hernández, H. Epidemiological and clinical characteristics of monkeypox among people with and without HIV in Peru: A national observational study. J. Infect Public Health. 17, 102494. https://doi.org/10.1016/j.jiph.2024.102494 (2024).

      Google Scholar 

    27. Curran, K.G. et al. HIV and sexually transmitted infections among persons with monkeypox - Eight U.S. jurisdictions, May 17-July 22, 2022. MMWR Morb. Mortal Wkly. Rep. 71, 1141–1147. https://doi.org/10.15585/mmwr.mm7136a1 (2022).

    28. Centro Nacional de Epidemiología – Unidad de vigilancia del VIH, ITS y hepatitis B y C. Actualización del continuo de atención del VIH en España, 2021. https://www.sanidad.gob.es/ciudadanos/enfLesiones/enfTransmisibles/sida/vigilancia/docs/Continuo_atencion_VIH_mayo_2023.pdf. Accessed 14 Feb 2025 (2023).

    29. Lazarus, J. V. et al. Disparities in HIV clinic care across Europe: Findings from the EuroSIDA clinic survey. BMC Infect. Dis. 16, 335. https://doi.org/10.1186/s12879-016-1685-x (2016).

      Google Scholar 

    30. Challacombe, S. J. Global inequalities in HIV infection. Oral Dis. 26(Suppl 1), 16–21. https://doi.org/10.1111/odi.13386 (2020).

      Google Scholar 

    31. GBD 2021 HIV Collaborators. Global, regional, and national burden of HIV/AIDS, 1990–2021, and forecasts to 2050, for 204 countries and territories: The Global Burden of Disease Study 2021. Lancet HIV 11, e807–e822 (2024).

    32. Laurenson-Schafer, H. et al. Description of the first global outbreak of mpox: An analysis of global surveillance data. Lancet Glob. Health 11, e1012–e1023. https://doi.org/10.1016/S2214-109X(23)00198-5 (2023).

      Google Scholar 

    33. Prevención de ITS. Ministerio de Sanidad de España. https://www.sanidad.gob.es/ciudadanos/enfLesiones/enfTransmisibles/sida/Campanas/prevencionITS/home.htm (2025)

    34. Ministerio de Sanidad. Instituto de Salud Carlos III. Situación epidemiológica de los casos de mpox en España. https://cne.isciii.es/documents/d/cne/situacion-epidemiologica-de-los-casos-de-mpox-310123. Accessed 11 Feb 2025 (2023).

    35. Instituto Nacional de Estadística. Cifras oficiales de población resultantes de la revisión del Padrón municipal a 1 de enero de 2021. Resumen por comunidades autónomas. (Official population figures resulting from the revision of the Municipal Register as of 2021 January 1. Population by Autonomous Communities). https://www.ine.es/jaxiT3/Tabla.htm?t=2915. Accessed 27 May 2024 (2021).

    36. UNESCO. International standard classification of education 2011. https://uis.unesco.org/sites/default/files/documents/international-standard-classification-of-education-isced-2011-en.pdf. Accessed 17 Oct 2024 (2011).

    Download references

    Funding

    This work was supported by CIBER Strategic Action for Monkeypox (Grant Number [MONKPOX-ESP22]) -Consorcio Centro de Investigación Biomédica en Red (CB 2021) and CIBERESP, Instituto de Salud Carlos III, Ministerio de Ciencia e Innovación and Unión Europea – NextGenerationEU and the Catalan Agency for the Management of Grants for University -AGAUR (Grant Number [2021/SGR 00702]).

    Author information

    Author notes

    1. A list of authors and their affiliations appears at the end of the paper.

    Authors and Affiliations

    1. Universitat de Barcelona, C. Casanova 143, 08036, Barcelona, Spain

      Aina March-Yagüe, Diana Toledo, Carles Pericas, María Grau, Angela Domínguez & Nuria Soldevila

    2. CIBER en Epidemiología y Salud Pública - CIBERESP, Madrid, Spain

      Diana Toledo, Pere Godoy, Carles Pericas, Alonso Sanchez-Migallon, María Dolores Chirlaque, Jesús Ospina, María Grau, Angela Domínguez, Nuria Soldevila, Pilar Ciruela, Ana Martínez, Joan Pau Millet & Cristina Rius

    3. Centro Nacional de Epidemiología, Madrid, Spain

      Asunción Díaz

    4. CIBER en Enfermedades Infecciosas-CIBERINFEC, Madrid, Spain

      Asunción Díaz, María Paz Sanchez-Seco & María Jose Sierra

    5. Institut de Recerca Biomèdica de Lleida-IRBLleida, Lleida, Spain

      Pere Godoy

    6. Dirección Xeral de Saúde Pública, Santiago de Compostela, Spain

      Olaia Pérez-Martínez

    7. Agència de Salut Pública de Barcelona, Barcelona, Spain

      Carles Pericas, Jesús Ospina, Joan Pau Millet & Cristina Rius

    8. Institut de Recerca Sant Pau, Barcelona, Spain

      Carles Pericas & Cristina Rius

    9. Consejería de Salud de La Región de Murcia-IMIB, Murcia, Spain

      Alonso Sanchez-Migallon & María Dolores Chirlaque

    10. Subdirección General de Epidemiología y Vigilancia de La Salud de La Comunidad Valenciana, Valencia, Spain

      Francisco Roig

    11. Consejería de Salud y Familias, Junta de Andalucía, Sevilla, Spain

      Nicola Lorusso & Miguel Mingo

    12. Servicio Andaluz de Salud, Sevilla, Spain

      Eduardo Briones

    13. Servicio de Epidemiología y Prevención, Dirección General de Salud Pública, Servicio Canario de la Salud, Las Palmas de Gran Canaria, Spain

      Laura García, Julio Morais, Óscar Pérez & Álvaro Torres

    14. Consejería de Sanidad, Dirección General de Salud Pública de Castilla y León, Valladolid, Spain

      Virginia Álvarez, Saray Martín & María del Carmen Pacheco

    15. Agencia de Salut Publica de Catalunya, Barcelona, Spain

      Itziar Martínez, Jacobo Mendioroz, Pilar Ciruela & Ana Martínez

    16. Department of Experimental and Health Sciences, Faculty of Health and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain

      Cristina Rius

    17. Universitat Politécnica de Catalunya, Barcelona, Spain

      Lesly Acosta

    18. Servizo de Epidemioloxía, Dirección Xeral de Saúde Pública, Xunta de Galicia, Galicia, Spain

      Ana Vázquez

    19. Departamento de Medicina Preventiva y Salud Pública, Universidad de Santiago de Compostela, Santiago de Compostela, Spain

      Carla Guerra-Tort & Lucía Martin-Gisbert

    20. Consejería de Salud, Región de Murcia, Murcia, Spain

      Lorena Aroca & Lorena Pérez

    21. Subdirecció General d’Epidemiologia, Vigilància de La Salut, Valencia, Spain

      Hermelinda Vanaclocha

    22. Centro Nacional de Microbiología, Madrid, Spain

      María Paz Sanchez-Seco

    23. Centro de Coordinación de Alertas y Emergencias Sanitarias, Madrid, Spain

      Bernardo Guzmán & María Jose Sierra

    Consortia

    The MONKPOX-ESP22 Subproject 3.2 Working Group

    • Nicola Lorusso
    • , Miguel Mingo
    • , Eduardo Briones
    • , Laura García
    • , Julio Morais
    • , Óscar Pérez
    • , Álvaro Torres
    • , Virginia Álvarez
    • , Saray Martín
    • , María del Carmen Pacheco
    • , Nuria Soldevila
    • , Itziar Martínez
    • , Jacobo Mendioroz
    • , Pilar Ciruela
    • , Ana Martínez
    • , Joan Pau Millet
    • , Cristina Rius
    • , Lesly Acosta
    • , Ana Vázquez
    • , Carla Guerra-Tort
    • , Lucía Martin-Gisbert
    • , Lorena Aroca
    • , Lorena Pérez
    • , Hermelinda Vanaclocha
    • , María Paz Sanchez-Seco
    • , Bernardo Guzmán
    •  & María Jose Sierra

    Contributions

    The study conception, design, and supervision were performed by, P.G, A.D, A.D. and D.T. Data collection were performed by, O.P.M., C.P., A.S.M., M.D.C., J.O., M.G. and F.R. The analysis and manuscript drafting were carry out by A.M.Y., A.D. and D.T. All authors commented on previous versions of the manuscript and approved the final manuscript.

    Corresponding author

    Correspondence to Diana Toledo.

    Ethics declarations

    Competing interests

    The authors declare no competing interests.

    Ethics

    The study protocol was formally approved by the Ethics Committee of Instituto de Salud Carlos III (CEI PI 69_2022). This approval ensured that the study was conducted in accordance with the principles of the Helsinki Declaration. No personally identifiable data from any subject were included, and all data were fully anonymized.

    Consent to participate

    All data were collected as part of routine public health surveillance activities, in accordance with the “Protocol for early detection and case management in the context of the mpox alert in Spain” [11], which was implemented in response to the ongoing multistate mpox outbreak. Consequently, written informed consent from patients was not required.

    Additional information

    Publisher’s note

    Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

    Supplementary Information

    About this article

    Check for updates. Verify currency and authenticity via CrossMark

    Cite this article

    March-Yagüe, A., Toledo, D., Díaz, A. et al. Mpox in people living with and without HIV, including people on PrEP, during a multistate outbreak in Spain in 2022. Sci Rep (2026). https://doi.org/10.1038/s41598-026-37209-3

    Download citation

    • Received03 June 2025

    • Accepted20 January 2026

    • Published20 February 2026

    • DOIhttps://doi.org/10.1038/s41598-026-37209-3

This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License

Source: Nature
https://www.nature.com/articles/s41598-026-37209-3


Back to ...
Positively Positive - Living with HIV/AIDS:
HIV/AIDS News


For more HIV and AIDS News visit...

Positively Positive - Living with HIV/AIDS: HIV/AIDS News Archive

HIV and AIDS News sorted by Month & Year

...positive attitudes are not simply 'moods'

Site Map

Contact Bradford McIntyre.

Copyright © 2003 - 2026 Bradford McIntyre. All rights reserved.

DESIGNED TO CREATE HIV & AIDS AWARENESS
spacer.gif