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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.