Abstract
Chagas disease (CD) is a neglected tropical disease that affects individuals in almost every country in Latin America. There are two available drugs with antiparasitic profiles; however, only benznidazole (BZN) has been approved for commercialization in Brazil. The usefulness of prescribing BZN for patients with chronic Chagas cardiomyopathy (CCC) is controversial. There are no studies in the literature describing the extent of BZN use at this stage or the profile of patients using this drug. The present study aimed to determine the prevalence and factors associated with previous BZN use among individuals with CCC. This cross-sectional study was conducted with 1,812 individuals with CCC from 21 Brazilian cities endemic for CD. The dependent variable was "prior use of BZN" (no vs. yes). The independent variables were grouped into socioeconomic, lifestyle and medical history aspects. Binary logistic regression (α ≥ 0.05) was used. Among the evaluated individuals, 27.2% reported previous use of BZN. The likelihood of prior use of BZN was higher among younger individuals (OR = 2.7), individuals with a higher education (OR = 2.7), individuals with a lower monthly per capita income (OR = 1.3), individuals who practiced physical exercise (OR = 1.5), individuals who had prior knowledge of the CD diagnosis (OR = 2.5), individuals without hypertension (OR = 1.3) and individuals with a longer time to the CD diagnosis (OR = 6.1). The present study revealed a small proportion of therapeutic BZN use among Brazilian CCC patients. This finding suggests a late diagnosis and undertreatment of the disease. BZN use was higher among individuals with better clinical and demographic conditions but with a lower income and a longer time to the CD diagnosis. Knowledge of the BZN usage profile may help reduce the current state of neglect of this disease and pave the way for future studies.
Highlights
Chagas disease (CD) is transmitted by Trypanosoma cruzi (T. cruzi) and is a neglected tropical disease that affects 10–12,000,000 individuals in almost every country in Latin America [1]
In Brazil, approximately 2,500,000 individuals are infected with T. cruzi; proper medical care must be arranged, for patients living in remote areas
The current study revealed that patients with Chronic Chagas’ cardiomyopathy (CCC) who were aware of the CD diagnosis were more likely to have previously taken BZN
Summary
Chagas disease (CD) is transmitted by Trypanosoma cruzi (T. cruzi) and is a neglected tropical disease that affects 10–12,000,000 individuals in almost every country in Latin America [1]. In Brazil, approximately 2,500,000 individuals are infected with T. cruzi; proper medical care must be arranged, for patients living in remote areas. Chronic Chagas’ cardiomyopathy (CCC) occurs in approximately 20 to 40% of infected people [4]. In Brazil, only BZN has been approved for commercialization, and it can be used by all patients in the acute phase of CD for at least 60 consecutive days [7,8]. This drug can be used by patients with the indeterminate form, mild cardiac involvement or the digestive form of the disease [7]. Despite reports demonstrating the efficacy of BZN in the acute phase of the infection, clinical results obtained in the chronic phase are more variable, and the occurrence of adverse events is more frequent, in adults [10]
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