WHO recommends rapid treatment initiation for people living with HIV and mpox
July 16, 2025
In its May 2025 guideline update, the World Health Organization (WHO) strongly recommends rapid initiation of antiretroviral therapy (ART) for individuals living with HIV who are diagnosed with mpox. This aligns with WHO’s broader strategy promoting same-day ART to reduce mortality and achieve viral suppression. People with advanced HIV, particularly those with CD4 counts below 200 cells/mm³, face significantly higher risks of severe mpox outcomes. WHO’s guidance also urges early HIV and syphilis testing in all suspected mpox cases, reinforcing the need for integrated care approaches to improve survival and reduce complications in co-infected patients.
The World Health Organization (WHO) has issued a decisive update in its May 2025 clinical management and infection prevention guidelines for mpox, recommending the rapid initiation of antiretroviral therapy (ART) in individuals living with HIV who are diagnosed with mpox. This recommendation is based on mounting evidence that people with HIV—especially those with advanced disease and CD4 counts below 200 cells/mm³—are at significantly higher risk for severe mpox, hospitalization, and death.
This aligns with WHO’s broader HIV treatment guidance, which strongly advocates for ART initiation ideally within seven days of diagnosis, including same-day treatment where feasible. While clinicians have voiced concerns about potential immune reconstitution inflammatory syndrome (IRIS) in co-infected patients, WHO concluded that the benefits of rapid ART initiation outweigh these risks. Given the limited availability of mpox-specific antivirals, early ART represents a critical tool in improving patient outcomes.
The guidance further underscores the importance of prompt HIV and syphilis testing for all individuals presenting with suspected or confirmed mpox. For those already receiving ART with suppressed viral loads, treatment should continue uninterrupted. This integrated care approach reflects WHO’s emphasis on mitigating severe disease outcomes and leveraging existing health infrastructure to deliver comprehensive patient care.
“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. In response, WHO has also published standard operating procedures to facilitate HIV and syphilis testing as part of the mpox response.
With mpox continuing to impact vulnerable populations globally, WHO’s evidence-based guidance highlights the life-saving potential of integrated HIV care in outbreak management and reinforces the need for accessible, timely diagnostics and treatment.