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Epidemiological-clinical profile and mortality in patients coinfected with Trypanosoma cruzi/HIV: experience from a Brazilian reference center
BACKGROUND: The recent urbanization of Chagas disease (CD) has contributed to a greater risk of coexistence with human immunodeficiency virus (HIV) and AIDS. METHODS: This retrospective observational study included patients who were followed at INI-Fiocruz between July 1986 and October 2021. All pat...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Sociedade Brasileira de Medicina Tropical - SBMT
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9592103/ https://www.ncbi.nlm.nih.gov/pubmed/36287507 http://dx.doi.org/10.1590/0037-8682-0240-2022 |
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author | Hasslocher-Moreno, Alejandro Marcel de Sousa, Andréa Silvestre Xavier, Sergio Salles Mendes, Fernanda de Souza Nogueira Sardinha Nunes, Estevão Portela Grinsztejn, Beatriz Gilda Jegerhorn Mediano, Mauro Felippe Felix |
author_facet | Hasslocher-Moreno, Alejandro Marcel de Sousa, Andréa Silvestre Xavier, Sergio Salles Mendes, Fernanda de Souza Nogueira Sardinha Nunes, Estevão Portela Grinsztejn, Beatriz Gilda Jegerhorn Mediano, Mauro Felippe Felix |
author_sort | Hasslocher-Moreno, Alejandro Marcel |
collection | PubMed |
description | BACKGROUND: The recent urbanization of Chagas disease (CD) has contributed to a greater risk of coexistence with human immunodeficiency virus (HIV) and AIDS. METHODS: This retrospective observational study included patients who were followed at INI-Fiocruz between July 1986 and October 2021. All patients underwent an assessment protocol that included sociodemographic profile, epidemiological history, and clinical evaluation. Descriptive data analyses included reports of the medians and frequencies of variables of interest. Differences in medians between groups were tested using the Mann-Whitney U test. Differences in frequency were tested using Fisher's exact test. RESULTS: Among 2201 patients, 11 (0.5%) were identified with Trypanosoma cruzi/HIV coinfection. Of these, 63.6% were women with a median age of 51.0 years old. Two patients had the indeterminate form of CD, six had the cardiac form, two had the digestive form and one had the cardio-digestive form. Half of the patients were undergoing antiretroviral treatment at the time of coinfection diagnosis with a median CD4+ count of 350 cells/μL and a viral load of 1500 copies/μL. Four patients underwent a xenodiagnosis test at coinfection diagnosis, which all yielded positive results; two of them presented high parasitemia under the risk of reactivation. Prophylaxis for CD reactivation was administered to four patients; two with ketoconazole and two with benznidazole. Six patients died after a median follow-up of 22.5 months, with AIDS being the most common cause of death. Only one case of reactivation was observed. CONCLUSIONS: Early diagnosis and prompt treatment of CD reactivation dramatically reduced mortality. Identification of Trypanosoma cruzi/HIV co-infection is crucial to planning a close follow-up of coinfected patients. |
format | Online Article Text |
id | pubmed-9592103 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Sociedade Brasileira de Medicina Tropical - SBMT |
record_format | MEDLINE/PubMed |
spelling | pubmed-95921032022-11-04 Epidemiological-clinical profile and mortality in patients coinfected with Trypanosoma cruzi/HIV: experience from a Brazilian reference center Hasslocher-Moreno, Alejandro Marcel de Sousa, Andréa Silvestre Xavier, Sergio Salles Mendes, Fernanda de Souza Nogueira Sardinha Nunes, Estevão Portela Grinsztejn, Beatriz Gilda Jegerhorn Mediano, Mauro Felippe Felix Rev Soc Bras Med Trop Major Article BACKGROUND: The recent urbanization of Chagas disease (CD) has contributed to a greater risk of coexistence with human immunodeficiency virus (HIV) and AIDS. METHODS: This retrospective observational study included patients who were followed at INI-Fiocruz between July 1986 and October 2021. All patients underwent an assessment protocol that included sociodemographic profile, epidemiological history, and clinical evaluation. Descriptive data analyses included reports of the medians and frequencies of variables of interest. Differences in medians between groups were tested using the Mann-Whitney U test. Differences in frequency were tested using Fisher's exact test. RESULTS: Among 2201 patients, 11 (0.5%) were identified with Trypanosoma cruzi/HIV coinfection. Of these, 63.6% were women with a median age of 51.0 years old. Two patients had the indeterminate form of CD, six had the cardiac form, two had the digestive form and one had the cardio-digestive form. Half of the patients were undergoing antiretroviral treatment at the time of coinfection diagnosis with a median CD4+ count of 350 cells/μL and a viral load of 1500 copies/μL. Four patients underwent a xenodiagnosis test at coinfection diagnosis, which all yielded positive results; two of them presented high parasitemia under the risk of reactivation. Prophylaxis for CD reactivation was administered to four patients; two with ketoconazole and two with benznidazole. Six patients died after a median follow-up of 22.5 months, with AIDS being the most common cause of death. Only one case of reactivation was observed. CONCLUSIONS: Early diagnosis and prompt treatment of CD reactivation dramatically reduced mortality. Identification of Trypanosoma cruzi/HIV co-infection is crucial to planning a close follow-up of coinfected patients. Sociedade Brasileira de Medicina Tropical - SBMT 2022-10-21 /pmc/articles/PMC9592103/ /pubmed/36287507 http://dx.doi.org/10.1590/0037-8682-0240-2022 Text en https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License |
spellingShingle | Major Article Hasslocher-Moreno, Alejandro Marcel de Sousa, Andréa Silvestre Xavier, Sergio Salles Mendes, Fernanda de Souza Nogueira Sardinha Nunes, Estevão Portela Grinsztejn, Beatriz Gilda Jegerhorn Mediano, Mauro Felippe Felix Epidemiological-clinical profile and mortality in patients coinfected with Trypanosoma cruzi/HIV: experience from a Brazilian reference center |
title | Epidemiological-clinical profile and mortality in patients coinfected with Trypanosoma cruzi/HIV: experience from a Brazilian reference center |
title_full | Epidemiological-clinical profile and mortality in patients coinfected with Trypanosoma cruzi/HIV: experience from a Brazilian reference center |
title_fullStr | Epidemiological-clinical profile and mortality in patients coinfected with Trypanosoma cruzi/HIV: experience from a Brazilian reference center |
title_full_unstemmed | Epidemiological-clinical profile and mortality in patients coinfected with Trypanosoma cruzi/HIV: experience from a Brazilian reference center |
title_short | Epidemiological-clinical profile and mortality in patients coinfected with Trypanosoma cruzi/HIV: experience from a Brazilian reference center |
title_sort | epidemiological-clinical profile and mortality in patients coinfected with trypanosoma cruzi/hiv: experience from a brazilian reference center |
topic | Major Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9592103/ https://www.ncbi.nlm.nih.gov/pubmed/36287507 http://dx.doi.org/10.1590/0037-8682-0240-2022 |
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