Advances and challenges in the treatment of Chagas disease - a global perspective

Abstract

Chagas disease, caused by Trypanosoma cruzi, is a global problem with an increasing impact on public health. Diagnosis and treatment of infected patients is considered to be key to its control. Current tools for primary and secondary prevention are able to interrupt transmission and control Chagas disease. The use of benznidazole and nifurtimox as anti-parasitic treatments for Chagas disease is indicated in the following situations: a) All acute phase patients, including congenital transmission; b) Following reactivation of infection by immune suppression; c) Patients up to 18 years of age with chronic disease; and d) Women of childbearing age with T. cruzi infection (with contraception during treatment). There is a relative consensus that drug treatment should be offered to adults aged 19–50 years without advanced heart disease, and is optional for those older than 50. Progress has been bolstered by the generation of clinical evidence on the safety and efficacy of new anti-parasitic treatment regimens from several clinical trials assessing new chemical entities. The BENDITA study (DNDi-Bolivia) is assessing new regimens of benznidazole, as a monotherapy and in combination with fosravuconazole. A trial to assess short regimens of fexinidazole is underway (DNDi-Spain). The MULTIBENZ trial (Berenice project-FP7-EU-Spain-Argentina-Brazil-Colombia); the BENZNIDAZOLE INTERMITTENT trial (HGAEV-INP-FMS-Argentina) and the CHICAMOCHA Trial (COLCIENCIAS-Colombia-Benznidazole-vs-Nifurtimox) are evaluating the efficacy and safety of different regimens of current trypanocides. These trials are all in the chronic phase of infection in adult patients. The CHICO trial (Multicenter trial-Bayer), is evaluating the safety and efficacy of a new paediatric formulation of nifurtimox. Ongoing clinical studies from DNDi, the NHEPACHA Network, and other groups are identifying and validating potential biological markers of therapeutic response in Chagas disease patients to support clinical development. Continued progress on these fronts will help ensure that diagnosis and treatment finally reach the over 99% of people with Chagas disease who have thus far been neglected. In order to reduce the burden of Chagas disease and to eliminate it as a public health issue, it is essential to incorporate diagnosis and treatment into public health strategy, and will be useful for primary, secondary, and tertiary prevention.