Mathematical modelling of pregnant women coinfected with HIV and ZIKV: A case study in endemic Latin American and Caribbean countries

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Abstract
Background: The dynamics of HIV and ZIKV coinfection among pregnant women remain understudied, and its impacts on neonatal health still need to be defined. This gap is particularly concerning given the significant public health risks it can cause, especially in Latin America and the Caribbean, where the Zika virus is still circulating. Methods: We conducted a transversal ecological study using aggregated data from 2015 to 2023. To do so, we developed a compartmental model that included a Susceptible-Infected-Recovered (SIR) compartment for pregnant women related to HIV and ZIKV infection status, as well as SI compartments for their newborns and ZIKV-carrying mosquitoes to perform simulations representing different epidemiological scenarios. We calculated the HIV/ZIKV basic reproduction number R0. Sensitivity analysis was performed to identify the model parameter with the greatest impact on this metric. Finally, we applied personal and sexual protection, medical treatment for Zika, and antiretroviral therapy as control measures against viral infections to evaluate the most effective strategy to improve neonatal health outcomes. Results: The basic reproduction number ℛ 0 associated with HIV/ZIKV coinfection among pregnant women varied in the range [0.09, 1.29] in the countries studied. The sensitivity analysis revealed that the ℛ 0 was most sensitive to the mosquito biting rate and the pregnant women’s death rate. ZIKV infection rate among pregnant women had a greater impact on the number of newborns with related health problems compared to HIV infection rate. The introduction of ZIKV among pregnant women was enough to cause a surge in the number of newborns with related health issues, demonstrating a greater impact than HIV on neonatal health. When control strategies were applied to the model, simulations demonstrated that their application needed to be maintained concurrently over time and that medical treatment of Zika was the measure having the least influence on the coinfection. Conclusion: Since pregnant women infected with HIV are particularly vulnerable to other infections such as ZIKV, it is crucial to improve antenatal care among them. Continued monitoring and increased prevention of HIV sexual transmission is also necessary to ensure maternal and child health. In order to optimize public health interventions, it is important to extend the research to strengthen our understanding of the implications of HIV-ZIKV coinfection among pregnant women and its effects on their children.

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