The impact of HIV coinfection on mpox patients: a systematic review and meta-analysis.

A substantial proportion of mpox cases occur in people with HIV, but how HIV coinfection and immune status affect clinical outcomes remains unclear. We systematically searched major databases up to March 2025 for observational studies comparing mpox patients with and without HIV coinfection. Pooled effect sizes were calculated using random-effects models. Risk ratios (RRs) or standardized mean differences (SMDs) with 95% confidence intervals were used for dichotomous or continuous outcomes. Post hoc subgroup analyses explored differences by economic development, viral suppression, and advanced HIV disease (AHD) proportion. Among 15,522 patients from 29 studies, 52.43% had HIV. HIV coinfection was associated with higher hospitalization [RR = 1.50, 95% CI (1.17, 1.93)] and mortality [RR = 4.54, 95% CI (2.11, 9.77)]. Coinfected patients had more syphilis, HBV, and HCV coinfections, and higher rates of fever, proctitis, malaise, rectal irritation syndrome, diarrhoea, skin and soft tissue infections, and pneumonia. Blood tests showed lower albumin, calcium, and haemoglobin, and higher CK-MB. Perianal lesions were more common with HIV. HIV coinfection is linked to greater clinical severity, mortality, and STI coinfections. Exploratory analyses suggest poor viral suppression may drive adverse outcomes, and lesion severity relates to immune status. All subgroup findings are post hoc and hypothesis-generating, limited by aggregate data. Intensified monitoring and supportive care, vaccination, and optimized ART initiation are crucial for this population.