{
  "abstract": "While high-income countries successfully contained mpox outbreaks with minimal mortality, West Africa faces a severe interaction in which mpox converges with advanced HIV disease (AHD). 1 Here, the term ‘syndemic’ refers to the interaction between biological vulnerability (advanced immunosuppression) and structural health system constraints that together amplify disease severity and adverse outcomes. Data from Sierra Leone show individuals living with HIV constitute 13%–83% of mpox inpatients and account for over 80% of deaths.2 In Nigeria, the case fatality rate reaches 20.8% among patients living with HIV and mpox, with coinfection conferring a 13.7-fold increased odds of death.1 Global evidence confirms this pattern, with HIV–mpox coinfection carrying a pooled mortality OR of 3.9, predominantly affecting those with CD4 counts <200 cells/µL.3 However, region-specific data remain limited, and some estimates are derived from studies conducted in other settings, which may affect their applicability to West-African contexts.",
  "authors": [
    {
      "affiliations": [
        "Ministry of Health/National Public Health Agency, Freetown, Sierra Leone",
        "Research and Scientific Division, Sustainable Health Systems, Freetown, Sierra Leone",
        "Insights for Development Impact, Freetown, Sierra Leone"
      ],
      "name": "Alpha Umaru Bai-Sesay"
    },
    {
      "affiliations": [
        "Institute for Development (IfD), Freetown, Sierra Leone"
      ],
      "name": "Augustus Osborne"
    },
    {
      "affiliations": [
        "Department of Emergency Medicine, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria"
      ],
      "name": "Obinna Innocent Oke"
    },
    {
      "affiliations": [
        "Department of Internal Medicine, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria"
      ],
      "name": "Aloubi Walter Emaka"
    },
    {
      "affiliations": [
        "Department of Internal Medicine, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria"
      ],
      "name": "Chizaram Onyeaghala"
    }
  ],
  "title": "A lifeline for the left behind: an urgent research agenda for mpox in advanced HIV",
  "uid": "ee6209ef-0dc0-5365-a52f-6ae875ebb14f"
}