Mpox in a couple living with HIV: relapse or reinfection?

Mpox is caused by a zoonotic Orthopoxvirus capable of infecting several animal species, including humans. The analysis of cases in the current outbreak showed that, differently from what happens in the classical disease, MPox has mostly affected men who have sex with men and bisexuals, including a high proportion of people living with HIV. The role of the immune system in fighting MPox has been discussed in literature and experts believe that immunity conferred by natural infection may be lifelong and advocate against the possibility of reinfection by Monkeypox virus. This report presents an HIV-infected men who have sex with men couple with cycles of MPox lesions after two different risk exposures. The clinical course of both cases and the temporal and anatomical relationship between the second cycle of Monkeypox virus lesions and the second exposure suggest the occurrence of reinfection. The genomic surveillance of Monkeypox virus, a better understanding of its interaction with the human host and knowledge of the post-infection and post-vaccine protection correlation are more relevant at this moment, when we observe an intersection of the MPox multi-country outbreak with the HIV/AIDS epidemic, considering the immunosenescence and other immune system issues caused by HIV.