Vaccination-dependent bifurcations in HIV-mpox co-infection dynamics: Synergistic effects and endemic stability

Résumé

The 2022 global monkeypox (Mpox) outbreak revealed sexual transmission as the dominant mode of spread, disproportionately affecting men who have sex with men (MSM) and creating novel challenges in HIV-endemic populations. We present the first mechanistic model capturing bidirectional HIV-Mpox interactions, incorporating three critical innovations: (1) HIV-induced immunological modulation of Mpox progression, (2) antiretroviral therapy (ART)-dependent transmission rates, and (3) vaccination stratification by HIV status. Our analysis demonstrates that HIV co-infection generates a backward bifurcation (critical threshold $\mathcal{R}_c=0.83$), enabling Mpox persistence even when $\mathcal{R}_0<1$, a phenomenon absent in single-pathogen models. The model reveals that untreated HIV increases Mpox susceptibility by 2.3-fold (95\% CI: 2.1-2.6), while current vaccination strategies show 38\% reduced efficacy in advanced HIV cases (CD4$^+$<200 cells/mm$^3$). Crucially, we identify an optimal intervention window where 60\% ART coverage combined with targeted vaccination reduces co-infection prevalence by 5.7$\times$ (95\% CI: 5.2--6.3) compared to isolated approaches. These findings resolve three key gaps in the 2022 response: (i) lack of co-infection-specific transmission metrics, (ii) unquantified ART-vaccination synergies, and (iii) HIV-stratified vaccine efficacy estimates. Our results provide a framework for integrated HIV-Mpox control, demonstrating that coordinated testing and prevention campaigns outperform sequential interventions by 21--34\% across epidemiological scenarios.

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