Chagas´ Disease and AIDS. The importance of an early diagnosis

pp. 339-445

Abstract

Objective: We evaluated way of transmission, reactivation and evolution of Chagas´ disease in HIV patients.
Research Design and Methods Hospitalized patients with AIDS and a positive Chagas serum reaction were included. Epidemiology, drug addiction, Chagas disease reactivation, the most affected target organ, time delay in the antiparasitic treatment onset and long term evolution were evaluated. Serology, parasite search in blood and cephalorachidian fluid, and complementary cardiologic and neurological studies were performed. The study was retrospective, observational; chi² and Fischer exact test were used as statistical methods.
Results Eight patients with Chagas´ disease and AIDS comorbidity were included. Transmission was vectorial in 5 patients (62,5%) and it was highly probable  by intravenous drug addiction in 3 patients (37,5%). 2  out of the 3 latter presented negative serum reaction for Chagas with positive blood parasite. Chagas disease reactivation was the institutionalisation cause in 5 patients (62,5%) and among these, 4 had CNS damage and 1 had myocarditis. Four out of 5 patients with Chagas disease reactivation died despite Benznidazol treatment. Mean time of treatment´s onset was 7 to 15 days.
Conclusions: Intravenous drug addiction is a high probability hypothesis for a new way of Chagas, disease transmission, in which serology is not relevant in the diagnosis of HIV positive patients with neurological damage. Chagas´ disease reactivation is frequent and the high mortality was related to the delay in diagnosis and treatment onset.