Understanding the Impact of HIV on MPOX Transmission in an MSM Population: A Mathematical Modeling Study

Abstract

The recent mpox outbreak (in 2022-2023) has different clinical and epidemiological features compared with previous outbreaks of the disease. During this outbreak, sexual contact was believed to be the primary transmission route of the disease. In addition, the community of men having sex with men (MSM) was disproportionately affected by the outbreak. This population is also disproportionately affected by HIV infection. Given that both diseases can be transmitted sexually, the endemicity of HIV, and the high sexual behavior associated with the MSM community, it is essential to understand the effect of the two diseases spreading simultaneously in an MSM population. Particularly, we aim to understand the potential effects of HIV on an mpox outbreak in the MSM population.

We develop a mechanistic mathematical model of HIV and mpox co-infection. Our model incorporates the dynamics of both diseases and consider HIV treatment with anti-retroviral therapy (ART). In addition, we consider a potential scenario where HIV infection increases susceptibility to mpox, and investigated the potential impact of this mechanism on mpox dynamics.

Our analysis shows that HIV can facilitate the spread of mpox in an MSM population, and that HIV treatment with ART may not be sufficient to control the spread of mpox in the population. However, we showed that a moderate use of condom or reduction in sexual contact in the population combined with ART is beneficial in controlling mpox transmission.

Based on our analysis, it is evident that an effective control of HIV, specifically through substantial ART use, moderate condom compliance, and reduction in sexual contact, is imperative for curtailing the transmission of mpox in an MSM population and mitigating the compounding impact of these intertwined epidemics.

Note:

Funding Information: This research is funded by the Canadian Institute for Health Research (CIHR) under the Mpox and other zoonotic threats Team Grant (FRN. 187246). W.A.W., J.D.K, and N.L.B. acknowledge financial support from the CIHR. W.A.W acknowledges financial support from the NSERC Discovery Grant (Appl No.: RGPIN-2023-05100). JDK acknowledges support from IDRC (Grant No. 109981). JDK equally acknowledges support from NSERC Discovery Grant (Grant No. RGPIN-2022-04559), NSERC Discovery Launch Supplement (Grant No: DGECR-2022-00454) and New Frontier in Research Fund- Exploratory (Grant No. NFRFE-2021-00879). Portions of this work were performed at the Los Alamos National Laboratory under the auspices of the US Department of Energy contract 89233218CNA000001 and supported by NIH grant R01-OD011095.

Conflict of Interests: The authors declare that there is no competing interest.

Keywords: HIV-mpox co-infection, infectious disease modeling, invasion reproduction number, control reproduction number, sensitivity analysis, MSM