Clinical profile and mortality in patients with T. Cruzi/HIV co-infection from the multicenter data base of the "network for healthcare and study of trypanosoma cruzi/HIV co-infection and other immunosuppression conditions"
Shikanai-Yasuda, Maria Aparecida (Universidade de São Paulo)
Mediano, Mauro Felippe (Oswaldo Cruz Foundation. Health Ministry (Rio de Janeiro, Brasil))
Gallafrio Novaes, Christina Terra (Universidade de São Paulo)
De Sousa, Andréa Silvestre (Oswaldo Cruz Foundation. Health Ministry (Rio de Janeiro, Brasil))
Sartori, Ana Marli Christovam (Universidade de São Paulo)
Santana, Rodrigo Carvalho (Ribeirão Preto Medical School University of São Paulo)
Correia, Dalmo (Federal University of Triângulo Mineiro (Uberaba, Brazil))
De Castro, Cleudson Nery (University of Brasilia)
Dos Santos Severo, Marilia Maria (Federal University of Health Sciences of Porto Alegre)
Hasslocher-Moreno, Alejandro Marce (Oswaldo Cruz Foundation. Health Ministry (Rio de Janeiro, Brasil))
Novaes, Mauro Felippe (Universidade de São Paulo)
Fernandez, Marisa Liliana (Hospital de Infecciosas (Buenos Aires, Argentina))
Salvador Velez, Fernando Maria (Hospital Universitari Vall d'Hebron)
Pinazo, Maria-Jesus (Hospital Clínic i Provincial de Barcelona)
Bolella, Valdes Roberto (Universidade de São Paulo)
Furtado, Pedro Carvalho (Federal University of Triângulo Mineiro (Uberaba, Brazil))
Corti, Marcelo (Universidad de Buenos Aires)
Pinto, Ana Yecê (Evandro Chagas Institute (Belém, Brazil))
Fica, Alberto (Universidad Austral de Chile)
Molina Romero, Israel (Hospital Universitari Vall d'Hebron)
Gascon, Joaquim (Hospital Clínic i Provincial de Barcelona)
Albajar Viñas, Pedro (World Health Organization)
Cortez-Escalante, Juan (World Health Organization)
Ramos, Ana Yecê (Federal University of Ceará (Fortaleza, Brasil))
De Almeida, Eros Antonio (State University of Campinas (Campinas, Brasil))
Universitat Autònoma de Barcelona

Fecha:	2021
Resumen:	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.
Derechos:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Lengua:	Anglès
Documento:	Article ; recerca ; Versió publicada
Materia:	Acquired Immunodeficiency Syndrome ; Adult ; Brazil ; CD4 Lymphocyte Count ; CD4-Positive T-Lymphocytes ; Chagas Disease ; Coinfection ; Cross-Sectional Studies ; Data Management ; Delivery of Health Care ; Female ; HIV Infections ; Humans ; Immunosuppression Therapy ; Male ; Middle Aged ; Retrospective Studies ; Trypanosoma cruzi ; Viral Load
Publicado en:	PLoS neglected tropical diseases, Vol. 15 Núm. 9 (september 2021) , p. e0009809, ISSN 1935-2735

DOI: 10.1371/journal.pntd.0009809
PMID: 34591866

18 p, 711.5 KB

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