Serologic Evidence of Mpox Virus Exposure Among People Living with HIV in Thailand Predating Clinical Recognition during the 2022 Outbreak

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ABSTRACT Objectives Mpox (also known as Monkeypox ) can cause significant morbidity in immunocompromised individuals, as evidenced in multiple recent outbreaks in non-endemic countries. We assessed orthopoxvirus IgG seroprevalence in an at-risk Thai cohort to identify prior exposure and associated clinical/behavioral features. Methods Archived 2022 specimens from an acute HIV cohort were selected based on risk criteria (multiple partners, STI history, or drug use). Samples were tested using the Meso Scale Discovery V-PLEX Orthopoxvirus IgG assay. Demographic, clinical, and behavioral data were analyzed using Mann–Whitney U and Fisher’s exact tests. Results Of 491 participants, 5.5% (27/491) were seropositive. Seropositivity was detected as early as January 2022, predating Thailand’s first clinical case (July 2022) and wastewater detection (June 2022). Only 7.4% (2/27) of seropositive participants had abnormal physical exams. Illicit drug use (74.1%) and meeting multiple behavioral risk criteria were significantly associated with seropositivity ( p < 0.001 and p = 0.029, respectively). No significant differences were found regarding CD4 counts, HIV viral suppression, or concurrent STIs. Conclusions Unrecognized, paucisymptomatic mpox transmission occurred in Thailand months before official detection. These findings highlight the utility of serologic surveillance within established high-risk cohorts for the early detection of emerging infectious threats.

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