HIV, COVID, and Monkeypox Diagnosed in Italian Man at the Same Time

According to a recent case report published in the Journal of Infection, a 36-year-old man in Italy appears to be the first person ever to be diagnosed with COVID-19, monkeypox, and HIV at the same time this summer.

He has been started on HIV medication and both his COVID-19 and monkeypox infections have resolved without any complications.

The study’s authors noted that SARS-CoV-2 infections and monkeypox virus infections can both happen at the same time. In high-risk people, flu-like symptoms and SARS-CoV-2 positivity should not rule out monkeypox.

The individual first fell ill on June 29, nine days after his return from a five-day trip to Spain, with a fever, sore throat, and headache, according to the case report written by infectious disease specialists in Italy. He tested positive for COVID-19 on July 2, and later that day, he discovered a rash on his left arm.

The rash turned into tiny, uncomfortable blisters over the course of the following few days, covering his face, body, legs, and glutes. He visited the emergency room of a hospital in Catania, Italy, on July 5, where he was later admitted to the infectious illness section.

The doctors assumed the patient had also contracted monkeypox based on the symptoms and recent vacation to Spain, so they took samples for testing. The individual claimed that while in Spain, he engaged in unprotected sex with other men, which has been linked to the current outbreak of monkeypox. He tested positive for HIV, COVID-19, and the BA.5.1 Omicron variation of COVID-19 on July 6. He also tested positive for monkeypox.

The doctors speculated that the patient may have contracted both COVID-19 and monkeypox at the same time based on the incubation times for both. (Symptoms of COVID-19 often show up 2 to 14 days after exposure, while those of monkeypox do so 3 to 17 days later.)

The patient informed the medical staff that his September 2021 HIV test result was negative. When the positive test came back in July, his CD4 lymphocyte count—a test that counts how many of these white blood cells are in the blood—was still within normal limits. He could have recently acquired HIV based on this.

The patient’s rashes started to crust and heal by the third day of hospitalisation, and by the fifth day, his symptoms had nearly completely subsided. He stopped testing positive for COVID-19 on July 13 and his monkeypox rash was almost healed on July 19, but he continued to test positive on July 19. The patient also started on a typical HIV combo therapy.

The Italian experts underlined that while the COVID-19 pandemic is still continuing strong and cases of monkeypox are rising, healthcare professionals should be aware that co-infection is conceivable in high-risk groups.

Since there is no publicly accessible therapy or prevention, healthcare systems “must be aware of this inevitability, promoting proper diagnostic tests in high-risk people, which are vital to containment,” they stated.

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