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

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.