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".
<h4>Objective</h4>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 Reac...
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2021
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oai:doaj.org-article:da5f3b3073a14f5b8487ae55d013f0c42021-12-02T20:23:59ZClinical 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".1935-27271935-273510.1371/journal.pntd.0009809https://doaj.org/article/da5f3b3073a14f5b8487ae55d013f0c42021-09-01T00:00:00Zhttps://doi.org/10.1371/journal.pntd.0009809https://doaj.org/toc/1935-2727https://doaj.org/toc/1935-2735<h4>Objective</h4>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.<h4>Methods</h4>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.<h4>Results</h4>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.<h4>Conclusion</h4>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.Maria Aparecida Shikanai-YasudaMauro Felippe Felix MedianoChristina Terra Gallafrio NovaesAndréa Silvestre de SousaAna Marli Christovam SartoriRodrigo Carvalho SantanaDalmo CorreiaCleudson Nery de CastroMarilia Maria Dos Santos SeveroAlejandro Marcel Hasslocher-MorenoMarisa Liliana FernandezFernando SalvadorMaria Jesús PinazoValdes Roberto BolellaPedro Carvalho FurtadoMarcelo CortiAna Yecê Neves PintoAlberto FicaIsrael MolinaJoaquim GasconPedro Albajar ViñasJuan Cortez-EscalanteAlberto Novaes RamosEros Antonio de AlmeidaPublic Library of Science (PLoS)articleArctic medicine. Tropical medicineRC955-962Public aspects of medicineRA1-1270ENPLoS Neglected Tropical Diseases, Vol 15, Iss 9, p e0009809 (2021) |
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Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 |
| spellingShingle |
Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 Maria Aparecida Shikanai-Yasuda Mauro Felippe Felix Mediano Christina Terra Gallafrio Novaes Andréa Silvestre de Sousa Ana Marli Christovam Sartori Rodrigo Carvalho Santana Dalmo Correia Cleudson Nery de Castro Marilia Maria Dos Santos Severo Alejandro Marcel Hasslocher-Moreno Marisa Liliana Fernandez Fernando Salvador Maria Jesús Pinazo Valdes Roberto Bolella Pedro Carvalho Furtado Marcelo Corti Ana Yecê Neves Pinto Alberto Fica Israel Molina Joaquim Gascon Pedro Albajar Viñas Juan Cortez-Escalante Alberto Novaes Ramos Eros Antonio de Almeida 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". |
| description |
<h4>Objective</h4>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.<h4>Methods</h4>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.<h4>Results</h4>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.<h4>Conclusion</h4>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. |
| format |
article |
| author |
Maria Aparecida Shikanai-Yasuda Mauro Felippe Felix Mediano Christina Terra Gallafrio Novaes Andréa Silvestre de Sousa Ana Marli Christovam Sartori Rodrigo Carvalho Santana Dalmo Correia Cleudson Nery de Castro Marilia Maria Dos Santos Severo Alejandro Marcel Hasslocher-Moreno Marisa Liliana Fernandez Fernando Salvador Maria Jesús Pinazo Valdes Roberto Bolella Pedro Carvalho Furtado Marcelo Corti Ana Yecê Neves Pinto Alberto Fica Israel Molina Joaquim Gascon Pedro Albajar Viñas Juan Cortez-Escalante Alberto Novaes Ramos Eros Antonio de Almeida |
| author_facet |
Maria Aparecida Shikanai-Yasuda Mauro Felippe Felix Mediano Christina Terra Gallafrio Novaes Andréa Silvestre de Sousa Ana Marli Christovam Sartori Rodrigo Carvalho Santana Dalmo Correia Cleudson Nery de Castro Marilia Maria Dos Santos Severo Alejandro Marcel Hasslocher-Moreno Marisa Liliana Fernandez Fernando Salvador Maria Jesús Pinazo Valdes Roberto Bolella Pedro Carvalho Furtado Marcelo Corti Ana Yecê Neves Pinto Alberto Fica Israel Molina Joaquim Gascon Pedro Albajar Viñas Juan Cortez-Escalante Alberto Novaes Ramos Eros Antonio de Almeida |
| author_sort |
Maria Aparecida Shikanai-Yasuda |
| title |
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". |
| title_short |
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". |
| title_full |
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". |
| title_fullStr |
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". |
| title_full_unstemmed |
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". |
| title_sort |
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". |
| publisher |
Public Library of Science (PLoS) |
| publishDate |
2021 |
| url |
https://doaj.org/article/da5f3b3073a14f5b8487ae55d013f0c4 |
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