Abstract
Chagas disease in patients with HIV infection represents a potentially serious event with high case fatality rates. This study describes epidemiological and clinical aspects of deaths related to Chagas disease and HIV/AIDS coinfection in Brazil, 1999–2007. We performed a descriptive study based on mortality data from the nationwide Mortality Information System. Of a total of about 9 million deaths, Chagas disease and HIV/AIDS were mentioned in the same death certificate in 74 cases. AIDS was an underlying cause in 77.0% (57) and Chagas disease in 17.6% (13). Males (51.4%), white skin color (50%), age group 40–49 years (29.7%), and residents in the Southeast region (75.7%) were most common. Mean age at death was significantly lower in the coinfected (47.1 years [SD ± 14.6]), as compared to Chagas disease deaths (64.1 years [SD ± 14.7], P < 0.001). Considering the lack of data on morbidity related to Chagas disease and AIDS coinfection, the use of mortality data may be an appropriate sentinel approach to monitor the occurrence of this association. Due to the epidemiological transition in Brazil, chronic Chagas disease and HIV/AIDS coinfection will be further complicated and require the development of evidence-based preventive control measures.
Highlights
Chagas disease, caused by the protozoan parasite Trypanosoma cruzi, is a well-known opportunistic infection in people living with HIV/AIDS [1,2,3,4,5,6]
Between 1999 and 2007, a total of 8,942,217 deaths occurred in Brazil, with 53,930 (0.6%) deaths related to Chagas
Acute Chagas disease with cardiac involvement (B57.0) (8.1%) and chronic Chagas disease affecting the nervous system (B57.4) (6.8%; Table 2) were more common among the HIV-infected as compared to all deaths by Chagas disease (2.5% and 0.3%, resp.). This is the first national population-based analysis of Brazilian mortality data related to Chagas disease and HIV/AIDS coinfection
Summary
Chagas disease, caused by the protozoan parasite Trypanosoma cruzi, is a well-known opportunistic infection in people living with HIV/AIDS [1,2,3,4,5,6]. Reactivation of chronic indeterminate Chagas disease in patients with HIV infection represents a serious event with high case fatality rates [1, 3, 4]. New aspects of the immunopathology of Chagas disease have been described recently in patients infected with HIV, and unusual clinical manifestations such as skin lesions, involvement of the central nervous system (meningoencephalitis), and/or serious heart damage (myocarditis) related to the reactivation of the disease have been reported [2,3,4]. The first case of HIV/T. cruzi coinfection was reported in the 1980s, but data on several issues are still scanty, such as the frequency of its occurrence, clinical and laboratorial profile of subjects with coinfection, survival rates, and mortality [1, 7, 8]. Chagas disease is endemic in 21 Latin American countries. The overlap of HIV infection and T. cruzi may occur in endemic areas, and in wealthier regions that receive an increasing number of potentially infected migrants [1, 6]
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