With global mpox cases surpassing 129,000 and deaths continuing to rise, the World Health Organization (WHO) is urging countries to prioritise HIV testing and treatment among patients with mpox. The warning is rooted in growing evidence that people with weakened immune systems, particularly those with untreated or poorly managed HIV, are at a much higher risk of developing severe complications or dying from mpox.
Mpox is a viral illness transmitted primarily through close personal contact, including sexual contact. Symptoms include painful skin lesions, fever, swollen lymph nodes, headache, fatigue, muscle aches, and back pain. While most cases are self-limiting, individuals with compromised immunity are more likely to experience prolonged or severe illness, requiring enhanced clinical attention.
In its updated clinical guidelines released this week, the WHO now recommends routine HIV testing for anyone with suspected or confirmed mpox infection. The call marks a major policy shift aimed at better integrating HIV and mpox responses to improve patient outcomes and limit further spread of the virus.
The updated guidance stems from mounting data indicating that individuals living with HIV especially those not on effective antiretroviral therapy (ART) are significantly more vulnerable to mpox complications. According to the WHO, children, pregnant people, and those with compromised immune systems, including individuals with uncontrolled HIV, are particularly at risk of serious illness or death due to mpox.
The new recommendations stress the urgent need for early HIV testing and immediate initiation of ART in any patient diagnosed with mpox who also tests positive for HIV. Early treatment not only manages HIV but also mitigates the severity of mpox and reduces the risk of secondary infections.
Supporting the guidance are five independent studies involving over 2,000 individuals, which showed that patients who delayed starting ART were about four times more likely to be hospitalised compared to those who began treatment early. Restoring immune function through ART is considered a key strategy in managing opportunistic infections when no effective treatment for the primary infection such as mpox is available.
The WHO further noted that the ongoing mpox outbreak, which began in 2022, has been driven by sustained human-to-human transmission in networks characterised by close physical contact. As of March 2025, over 129,000 confirmed cases and 283 deaths have been recorded in 130 countries and territories across all global regions.
In addition to the HIV-focused guidance, new protocols were also issued for managing mpox in breastfeeding mothers. Women infected with mpox are advised to avoid direct skin-to-skin contact with their infants if lesions are present on the breasts or other parts of the body. Mothers who pause breastfeeding during infection are encouraged to resume once they have clinically recovered, provided they maintain strict hygiene.
Symptoms of mpox typically appear within one week of exposure but may take up to 21 days to manifest. While the illness usually lasts two to four weeks, in immunocompromised individuals it may linger and worsen, potentially leading to more severe conditions such as painful rectal inflammation, difficulty swallowing, or trouble urinating.
Governments around the world are being urged to incorporate the updated guidance into their national response strategies, especially in high-risk populations such as people living with HIV and infants. The aim is to ensure that vulnerable individuals receive timely care and appropriate interventions that can save lives and prevent further transmission.
