Abstract
BackgroundThe effectiveness of anti-parasite treatment with benznidazole in the chronic Chagas disease (ChD) remains uncertain. We evaluated, using data from the NIH-sponsored SaMi-Trop prospective cohort study, if previous treatment with benznidazole is associated with lower mortality, less advanced cardiac disease and lower parasitemia in patients with chronic ChD.MethodsThe study enrolled 1,959 ChD patients and abnormal electrocardiogram (ECG) from in 21 remote towns in Brazil. A total of 1,813 patients were evaluated at baseline and after two years of follow-up. Those who received at least one course of benznidazole were classified as treated group (TrG = 493) and those who were never treated as control group (CG = 1,320). The primary outcome was death after two-year follow-up; the secondary outcomes were presence at the baseline of major ChD-associated ECG abnormalities, NT-ProBNP levels suggestive of heart failure, and PCR positivity.ResultsMortality after two years was 6.3%; it was lower in the TrG (2.8%) than the CG (7.6%); adjusted OR: 0.37 (95%CI: 0.21;0.63). The ECG abnormalities typical for ChD and high age-adjusted NT-ProBNP levels suggestive of heart failure were lower in the TrG than the CG, OR: 0.35 [CI: 0.23;0.53]. The TrG had significantly lower rates of PCR positivity, OR: 0.35 [CI: 0.27;0.45].ConclusionPatients previously treated with benznidazole had significantly reduced parasitemia, a lower prevalence of markers of severe cardiomyopathy, and lower mortality after two years of follow-up. If used in the early phases, benznidazole treatment may improve clinical and parasitological outcomes in patients with chronic ChD.Trial registrationClinicalTrials.gov, Trial registration: NCT02646943.
Highlights
Chagas disease (ChD), caused by the protozoa Trypanosoma cruzi, is one of the most important neglected diseases and a leading cause of cardiopathy and death in Latin America, [1][2] where it is endemic with an estimated 5.7 million infected people [3]
The ECG abnormalities typical for ChD and high age-adjusted NT-ProBNP levels suggestive of heart failure were lower in the TrG than the CG, odds ratios (OR): 0.35 [CI: 0.23;0.53]
Patients previously treated with benznidazole had significantly reduced parasitemia, a lower prevalence of markers of severe cardiomyopathy, and lower mortality after two years of follow-up
Summary
Chagas disease (ChD), caused by the protozoa Trypanosoma cruzi, is one of the most important neglected diseases and a leading cause of cardiopathy and death in Latin America, [1][2] where it is endemic with an estimated 5.7 million infected people [3]. After remission of the acute manifestations, most patients enter a chronic phase without clinical manifestations of the disease, the so-called chronic indeterminate form of ChD, which can persist for decades or be lifelong, or can evolve. Chagas cardiomyopathy is the most serious manifestation of ChD and may present as heart failure, ventricular arrhythmias, heart block, or thromboembolic phenomena [1]; ~2% of indeterminate form patients evolve to clinically diagnosed cardiac disease each year [5]. The effectiveness of anti-parasite treatment with benznidazole in the chronic Chagas disease (ChD) remains uncertain. We evaluated, using data from the NIH-sponsored SaMiTrop prospective cohort study, if previous treatment with benznidazole is associated with lower mortality, less advanced cardiac disease and lower parasitemia in patients with chronic ChD
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