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    Attaching a stigma to the LGBTQI plus community should be avoided during the monkeypox epidemic
    (Wiley, 2023) Bragazzi, Nicola Luigi; Khamisy-Farah, Rola; Tsigalou, Christina; Mahroum, Naim; Converti, Manlio
    Dear Editor,An outbreak of monkeypox, a rare zoonotic disease caused by anorthopoxvirus, is currently ongoing and has spread so far to morethan 20 countries, mostly affecting Europe, the Americas, Australia,and Israel, with more than 400 confirmed cases (https://bnonews.com/monkeypox/), becoming the largest monkeypox epidemicoutside of western and central Africa, where it is endemic in elevencountries.1In the UK, where the first monkeypox case was reportedon May 7, 2022, in a traveler returning from Nigeria, the National“Health Security Agency”(UKHSA) has reported that“a notableproportion of early cases detected have been in gay and bisexual menand so UKHSA is urging this community in particular to be alert”
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    Epidemiological trends and clinical features of the ongoing monkeypox epidemic: A preliminary pooled data analysis and literature review
    (Wiley, 2023) Bragazzi, Nicola L.; Kong, Jude D.; Mahroum, Naim; Tsigalou, Christina; Khamisy-Farah, Rola; Converti, Manlio; Wu, Jianhong
    An emerging outbreak of monkeypox infection is quickly spreading worldwide, being currently reported in more than 30 countries, with slightly less than 1000 cases. In the present preliminary report, we collected and synthesized early data concerning epidemiological trends and clinical features of the ongoing outbreak and we compared them with those of previous outbreaks. Data were pooled from six clusters in Italy, Australia, the Czech Republic, Portugal, and the United Kingdom, totaling 124 cases (for 35 of which it was possible to retrieve detailed information). The ongoing epidemic differs from previous outbreaks in terms of age (54.29% of individuals in their thirties), sex/gender (most cases being males), risk factors, and transmission route, with sexual transmission being highly likely. Also, the clinical presentation is atypical and unusual, being characterized by anogenital lesions and rashes that relatively spare the face and extremities. The most prevalent sign/symptom reported was fever (in 54.29% of cases) followed by inguinal lymphadenopathy (45.71%) and exanthema (40.00%). Asthenia, fatigue, and headache were described in 22.86% and 25.71% of the subjects, respectively. Myalgia was present in 17.14% of the cases. Both genital and anal lesions (ulcers and vesicles) were reported in 31.43% of the cases. Finally, cervical lymphadenopathy was described in 11.43% of the sample, while the least commonly reported symptoms were diarrhea and axillary lymphadenopathy (5.71% of the case series for both symptoms). Some preliminary risk factors can be identified (being a young male, having sex with other men, engaging in risky behaviors and activities, including condomless sex, human immunodeficiency virus positivity (54.29% of the sample analyzed), and a story of previous sexually transmitted infections, including syphilis). On the other hand, being fully virally suppressed and undetectable may protect against a more severe infectious course. However, further research in the field is urgently needed.
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    HIV pre-exposure prophylaxis and its impact on the gut microbiome in men having sex with men
    (Frontiers Media S.A., 2022) Bragazzi, Nicola Luigi; Khamisy-Farah, Rola; Tsigalou, Christina; Mahroum, Naim
    HIV/AIDS still imposes a high epidemiological and societal burden. Together with antiretroviral therapy, pre-exposure prophylaxis (PrEP) represents a fundamental tool in the fight against HIV/AIDS. PrEP is considered effective and safe, even though it may affect organs like the kidney, bone, and liver, as shown by randomized clinical trials (RCTs). These side effects may be mediated by alterations of the gut microbiome. Whilst the impact of the human rectal and vaginal microbiome on HIV prevention has been highly investigated among women, less is known about its effect among men having sex with men (MSM), a vulnerable population at high risk for HIV and disproportionately affected by HIV/AIDS. In the present paper, we will overview the effects of PrEP on the gut microbiota in MSM. Mining PubMed/MEDLINE, we identified three studies that have found significant changes affecting the gut microbiota. However, these shifts in the gut microbiome composition are variable, probably due to methodological differences, even though all studies reviewed in the present overview consistently report aberrations at the level of the gut microbiota. More data are needed, especially concerning the long-term side effects of PrEP: despite the studies included being a high-quality RCT, and two well-designed cross-sectional studies, evidence related to the impact of HIV PrEP on the gut microbiome in MSM is scarce and based on small populations. A better understanding of the interactions between the gut microbiota, sexual orientation/identity, and HIV prevention is expected to improve PrEP adherence and devise strategies to counteract PrEP-related side effects.