The World Health Organization (WHO) has released new clinical guidelines for the management of mpox, with a particular focus on protecting high-risk groups. Central to the updated recommendations is the routine HIV testing of all individuals diagnosed with mpox, reflecting increasing evidence that people living with HIV are at a much greater risk of developing severe mpox complications and experiencing higher mortality rates.
According to the new guidance, people at higher risk for serious illness and death due to mpox include children, pregnant individuals, and those with weakened immune systems especially those with uncontrolled HIV. The WHO emphasizes that anyone diagnosed with mpox who tests positive for HIV should start antiretroviral therapy (ART) immediately. This is part of a broader strategy to ensure that vulnerable patients receive timely and appropriate care.
The updated recommendations highlight the importance of early HIV testing for individuals showing symptoms of mpox. Early intervention, including HIV testing and prompt initiation of ART, is considered crucial in preventing the progression to severe disease. This marks a significant shift in the approach to managing mpox, acknowledging the overlapping demographics of mpox and HIV-affected populations and underscoring the need for integrated treatment responses.
Mpox is a viral illness primarily transmitted through close contact between individuals. It causes painful skin lesions and is often accompanied by fever, swollen lymph nodes, muscle aches, back pain, fatigue, and other flu-like symptoms. While most people recover without specialized treatment, the illness can become life-threatening in those with compromised immune systems.
The updated guidelines reflect the evolving nature of the global mpox outbreak, which has persisted since 2022 and continues to be sustained by human-to-human transmission, including sexual contact. As of March 2025, over 129,000 confirmed mpox cases and 283 deaths had been reported across 130 countries. More recent data shows that since the start of 2024, over 37,000 cases and 125 deaths have occurred in 25 countries, with a significant proportion of fatalities among individuals with compromised immunity.
The WHO’s clinical findings show that patients who delayed starting ART were nearly four times more likely to be hospitalized. This is particularly concerning given that there is currently no proven, effective treatment for mpox itself. In individuals with untreated HIV, the virus continues to replicate, leading to worsening symptoms. Early ART initiation not only helps to manage HIV but also improves the body’s ability to fight opportunistic infections, including mpox.
Additional recommendations in the guidelines address special populations such as breastfeeding mothers. Women infected with mpox are advised to avoid direct skin-to-skin contact with their infants if they have visible lesions, especially on the breast or torso. Once clinically recovered, mothers are encouraged to resume breastfeeding, provided they observe strict hygiene measures and are physically able to do so.
The WHO urges national health authorities, including Kenya’s Ministry of Health, to incorporate these updated protocols into their response strategies. This is particularly important for safeguarding high-risk populations such as infants and people living with HIV.
Mpox symptoms generally emerge within one week of exposure, though the incubation period can range from 1 to 21 days. While most people recover within two to four weeks, individuals with weakened immune systems may suffer longer or more severe illness. Beyond the classic rash often affecting the palms, soles, and genital areas patients may experience complications such as painful inflammation of the rectum, difficulty urinating, or painful swallowing.
The new guidelines mark a critical step in improving mpox management and reducing the burden of the disease on vulnerable populations through integrated and timely care.
