Lista de Siglas/Abreviaturas 18 F-FDG – fluordesoxiglicose marcado com flúor-18 123 I-MIBG – meta-iodo-benzil-guanidina marcado com iodo-123 […] Diretriz da SBC sobre Diagnóstico e Tratamento de Pacientes com Cardiomiopatia da Doença de Chagas – 2023 Lista de Siglas/Abreviaturas 18 F-FDG – fluordesoxiglicose marcado com flúor-18 123 I-MIBG – meta-iodo-benzil-guanidina marcado com iodo-123 […] Diretriz da SBC sobre Diagnóstico e Tratamento de Pacientes com Cardiomiopatia da Doença de Chagas – 2023

Chagas disease (CD) globalization facilitated the co-infection with Human Immunodeficiency Virus (HIV) in endemic and non-endemic areas. Considering the underestimation of Trypanosoma cruzi (T. cruzi)-HIV co-infection and the risk of life-threatening Chagas Disease Reactivation (CDR), this study aimed to analyze the major co-infection clinical characteristics and its mortality rates. This is a cross-sectional retrospective multicenter study of patients with CD confirmed by two serological or one parasitological tests, and HIV infection confirmed by immunoblot. CDR was diagnosed by direct microscopy with detection of trypomastigote forms in the blood or other biological fluids and/or amastigote forms in inflammatory lesions. Out of 241 patients with co-infection, 86.7% were from Brazil, 47.5% had <200 CD4⁺ T cells/μL and median viral load was 17,000 copies/μL. Sixty CDR cases were observed. Death was more frequent in patients with reactivation and was mainly caused by CDR. Other causes of death unrelated to CDR were the manifestation of opportunistic infections in those with Acquired Immunodeficiency Syndrome. The time between the co-infection diagnosis to death was shorter in patients with CDR. Lower CD4⁺ cells count at co-infection diagnosis was independently associated with reactivation. Similarly, lower CD4⁺ cells numbers at co-infection diagnosis and male sex were associated with higher lethality in CDR. Additionally, CD4⁺ cells were lower in meningoencephalitis than in myocarditis and milder forms. This study showed major features on T. cruzi-HIV co-infection and highlighted the prognostic role of CD4⁺ cells for reactivation and mortality. Since lethality was high in meningoencephalitis and all untreated patients died shortly after the diagnosis, early diagnosis, immediate antiparasitic treatment, patient follow-up and epidemiological surveillance are essentials in T. cruzi/HIV co-infection and CDR managements. Chagas disease (CD) is a chronic infectious disease caused by the parasite T. cruzi that accounts for a major burden due to its life-lasting morbidity in endemic and non-endemic areas. Globalization facilitated the meeting of CD and Human Immunodeficiency Virus (HIV) infection (T. cruzi/HIV co-infection). Patients with this co-infection are at risk of life-threatening CDR. This study aimed to analyze the clinical characteristics and mortality rates of patients with T. cruzi/HIV co-infection. This retrospective multicenter study included 241 patients with co-infection, of those 60 with CDR. Death was more frequent in patients with reactivation and was mainly caused by CDR. Our data showed that co-infection diagnosis is close to the reactivation diagnosis and characterized by poor immune response associated to CDR, higher lethality and more severe forms of CDR (meningoencephalitis). This study emphasizes the prognostic role of CD4⁺ cells on reactivation and mortality and the need of epidemiological surveillance for co-infection and CDR.

We aimed to describe the sociodemographic, epidemiological, and clinical characteristics of patients with chronic Chagas disease (CD) at an infectious disease referral center. Changes in patient profiles over time were also evaluated. This retrospective study included patients with CD from November 1986-December 2019. All patients underwent an evaluation protocol that included sociodemographic profile; epidemiological history; anamnesis; and physical, cardiologic, and digestive examinations. Trend differences for each 5-year period from 1986 to 2019 were tested using a nonparametric trend test for continuous and generalized linear models with binomial distribution for categorical variables. A total of 2,168 patients (52.2% women) were included, with a mean age of 47.8 years old. White patients with low levels of education predominated. The reported transmission mode was vectorial in 90.2% of cases. The majority came from areas with a high prevalence (52.2%) and morbidity (67.8%) of CD. The most common clinical presentation was the indeterminate form (44.9%). The number of patients referred gradually decreased and the age at admission increased during the study period, as did the patients' levels of education. The clinical profile of CD is characterized by a predominance of the indeterminate form of the disease. Regarding the patients who were followed up at the referral center, there was a progressive increase in the mean age and a concomitant decrease in the number of new patients. This reflects the successful control of vector and transfusion transmission in Brazil as well as the aging population of patients with CD.