Another paper on hepatitis C: absence of backward bifurcations

In a previous post I wrote about a paper by Alexis Nangue, myself and others on an in-host model for hepatitis C. In that context we were able to prove various things about the solutions of that model but there were many issues we were not able to investigate at that time. Recently Alexis visited Mainz for a month, funded by an IMU-Simons Foundation Africa Fellowship. In fact he had obtained the fellowship a long time ago but his visit was delayed repeatedly due to the pandemic. Now at last he was able to come. This visit gave us the opportunity to investigate the model from the first paper further and we have now written a second paper on the subject. In the first paper we showed that when the parameters satisfy a certain inequality every solution converges to a steady state as t\to\infty. It was left open, whether this is true for all choices of parameters. In the second paper we show that it is not: there are parameters for which periodic solutions exist. This is proved by demonstrating the presence of Hopf bifurcations. These are obtained by a perturbation argument starting from a simpler model. Unfortunately we could not decide analytically whether the periodic solutions are stable or unstable. Simulations indicate that they are stable at least in some cases.

Another question concerns the number of positive steady states. In the first paper we showed under a restriction on the parameters that there are at most three steady states. This has now been extended to all positive parameters. We also show that the number of steady states is even or odd according to the sign of R_0-1, where R_0 is a basic reproductive ratio. It was left open, whether the number of steady states is ever greater than the minimum compatible with this parity condition. If there existed backward bifurcations (see here for the definition) it might be expected that there are cases with R_0<1 and two positive solutions. We proved that in fact this model does not admit backward bifurcations. It is known that a related model for HIV with therapy (Nonlin. Anal. RWA 17, 147) does admit backward bifurcations and it would be interesting to have an intuitive explanation for this difference.

In the first paper we made certain assumptions about the parameters in order to be able to make progress with proving things. In the second paper we drop these extra restrictions. It turns out that many of the statements proved in the first paper remain true. However there are also new phenomena. There is a new type of steady state on the boundary of the positive orthant and it is asymptotically stable. What might it mean biologically? In that case there are no uninfected cells and the state is maintained by infected cells dividing to produce new infected cells. This might represent an approximate description of a biological situation where almost all hepatocytes are infected.

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