Chagas’ disease and HIV co-infection in patients without effective antiretroviral therapy: prevalence, clinical presentation and natural history

• Published in: Transactions of the Royal Society of Tropical Medicine and Hygiene Vol. 104; no. 7; pp. 447 - 452
• Main Authors: Almeida, Eros A., Lima, Josué N., Lages-Silva, Eliane, Guariento, Maria E., Aoki, Francisco H., Torres-Morales, Ana E., Pedro, Rogério J.
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier Ltd 01-07-2010; Royal Society of Tropical Medicine and Hygiene; Oxford University Press
• Subjects: Adolescent; Adult; Aged; AIDS; American trypanosomiasis; Biological and medical sciences; Brazil - epidemiology; Chagas Cardiomyopathy - diagnosis; Chagas Cardiomyopathy - epidemiology; Chagas Cardiomyopathy - virology; Chagas Disease - diagnosis; Chagas Disease - epidemiology; Chagas Disease - virology; Chagas’ disease; Co-infection; Cross-Sectional Studies; Female; General aspects; HIV; HIV Infections - diagnosis; HIV Infections - epidemiology; HIV Infections - virology; Human immunodeficiency virus; Human protozoal diseases; Human viral diseases; Humans; Infectious diseases; Longitudinal Studies; Lymphocyte Count - methods; Male; Medical sciences; Middle Aged; Parasitic diseases; Prevalence; Protozoal diseases; reactivation; Sex Distribution; Trypanosomiasis; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids; Viral Load; Young Adult; Brazil; American trypanosomiasis; AIDS; reactivation; Co-infection; HIV; Chagas’ disease; Protozoal disease; Antiretroviral agent; Mixed infection; Prevalence; Chagas disease; Epidemiology; Case history; Co-infection reactivation; Antiviral; Tropical medicine; Trypanosomiasis; Immunopathology; Reactivation; Retroviridae; Parasitosis; Immune deficiency; Lentivirus; Infection; Virus; Symptomatology; Chemotherapy; Treatment; Viral disease; Human immunodeficiency virus; Chagas' disease
• ISSN: 0035-9203; 1878-3503
• DOI: 10.1016/j.trstmh.2010.02.004

The objectives of this study were to establish the prevalence of Chagas’ disease among HIV seropositive patients and to define the clinical profile of co-infected cases. Cross-sectional study: the prevalence of co-infected subjects was 1.3% and there was no significant difference between co-infected and non co-infected patients relative to race, birthplace, home address and CD4 T cells. The co-infected group comprised predominantly women and mean age and median viral load were higher. Longitudinal study: included 20 patients (12 women) and described the clinical presentation and natural history of concomitant infections. The mean follow-up time was 35.8 months, mean age was 43
±
8.7 years and 60% of patients were white. During the follow-up, a total of 113 serological tests for Chagas’ disease were performed: 89 (78.8%) were reactive/positive, 21 (18.6%) were doubtful and three (2.6%) were non-reactive/negative. Positive results for xenodiagnosis were high (81%). At the baseline evaluation, thirteen patients had the indeterminate form of Chagas’ disease and seven cardiopathy. One patient developed from indeterminate to digestive form, three had a reactivation of Chagas’ disease in the central nervous system, all had parasitological confirmation and received specific treatment. There were 11 deaths. Thus, HIV-infected patients should be tested for Chagas’ disease when epidemiologically relevant.