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

Abstract

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. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1038/s41598-026-37209-3.