Clinical and Immunological Insights into Chikungunya Virus Infection in People Living with HIV

Chikungunya virus (CHIKV) is a globally emerging arthropod-borne virus causing widespread febrile outbreaks, with its endemic regions showing extensive geographical overlap with human immunodeficiency virus (HIV). Approximately 71% of people living with HIV (PLWH) reside in CHIKV high-risk areas globally, while the clinical features and underlying immunological interplay of CHIKV-HIV co-infection have not been systematically synthesized. This review integrates current evidence on CHIKV host immune responses, alongside the epidemiological characteristics, clinical manifestations, and immunopathological mechanisms of CHIKV infection in PLWH, to deliver integrated clinical and immunological insights into co-infection. Available data indicate that PLWH on suppressive antiretroviral therapy (ART) generally present with milder CHIKV disease, with potential mechanisms involving HIV-induced immune system alterations and direct antiviral activity of ART. This review provides an evidence-based framework for clinical management and public health prevention strategies for this vulnerable population.