WHO Urges Rapid Treatment for Concurrent HIV and Mpox
July 28, 2025
The World Health Organization has issued updated guidance urging rapid initiation of antiretroviral therapy (ART) for people living with HIV who are diagnosed with mpox. The recommendation—presented at the 2025 International AIDS Society Conference—emphasizes that ART should ideally begin within seven days of HIV diagnosis. People with low CD4 counts are at particular risk for severe mpox illness and death, underscoring the urgency of early HIV treatment in co-infected patients. While data on immune reconstitution inflammatory syndrome remain limited, WHO asserts that the clear benefits of early ART outweigh the risks, marking a vital step toward integrated viral care.
In a significant step toward integrated viral care, the World Health Organization (WHO) has updated its clinical guidance to strongly recommend rapid initiation of antiretroviral therapy (ART) for people living with HIV who are diagnosed with mpox. Announced at the 2025 International AIDS Society Conference on HIV Science, the new directive underscores that ART should begin within seven days of HIV diagnosis—and on the same day when feasible.
The update is driven by growing evidence that HIV-positive individuals are disproportionately affected by mpox, experiencing higher rates of severe disease and mortality compared to HIV-negative individuals. Those with low CD4 counts (<200 cells/mm³) are especially vulnerable, and in the absence of effective mpox-specific therapeutics, early HIV treatment becomes even more critical.
Remco Peters, MD, WHO medical officer and presenter of the updated guidelines, acknowledged concerns over immune reconstitution inflammatory syndrome (IRIS) in the context of mpox. However, the guideline developers concluded that the clear benefits of immediate ART initiation—including reduced mortality and progression—outweigh the theoretical risks associated with IRIS.
In practical terms, WHO urges clinicians to test all patients presenting with suspected or confirmed mpox for HIV and to offer prompt referral for ART initiation. Patients already on ART should continue their regimen without interruption. Those with unsuppressed viral loads should be appropriately managed, with no change required for patients with undetectable HIV RNA.
This recommendation aligns with WHO’s broader policy on same-day ART start and reflects a growing recognition of the importance of integrated care for overlapping infectious diseases. As mpox continues to spread in populations with high HIV prevalence, particularly in Central and West Africa, the guidance offers a timely and evidence-informed approach to improving outcomes for those at greatest risk.