Course of serological tests in treated subjects with chronic Trypanosoma cruzi infection: A systematic review and meta-analysis of individual participant data

Abstract

HighlightsThis is the first meta-analysis of individual data in chronic Trypanosoma cruzi infection after treatment.The probability of seroreversion is variable along the course of follow-up.An interaction was found between age at treatment and country setting.The course of parasitological/molecular tests after treatment needs to be assessed.

Efficacy and safety assessment of different dosage of benznidazol for the treatment of Chagas disease in chronic phase in adults (MULTIBENZ study): study protocol for a multicenter randomized Phase II superiority clinical trial

“…Antitrypanosomal treatment is always recommended for acute and congenital CD, reactivated CD infections, and chronic CD in individuals younger than 18 years of age [3,12]. Despite the limitations of treatment of chronic CD in adults, international guidelines recommend treatment with either BNZ or nifurtimox in patients under 50 years old with nonestablished cardiac complications [13,14]. This is based mainly on the lower long-term clinical progression observed in patients treated with BNZ after a mean follow-up of 10 years, the parasite persistence and concomitant chronic inflammation underlying CCM, and the prevention of vertical transmission to children born by infected women and treated before pregnancy [3,15].…”

WHF IASC Roadmap on Chagas Disease

“…In the absence of a gold standard, serological tests to confirm cure and molecular tests to demonstrate failure are the best available tools to assess response to antiparasitic treatment in the chronic phase. While positive PCR during the first 24 months after treatment is indicative of therapeutic failure, sensitivity is variable [97,98]. Post-treatment sero-negativization can take several years, depending on: (i) the age of the individual at time of treatment; (ii) the time elapsed between treatment and follow-up, and (iii) the region where the individual was infected [98,99,100].…”

“…While positive PCR during the first 24 months after treatment is indicative of therapeutic failure, sensitivity is variable [97,98]. Post-treatment sero-negativization can take several years, depending on: (i) the age of the individual at time of treatment; (ii) the time elapsed between treatment and follow-up, and (iii) the region where the individual was infected [98,99,100]. Although complete sero-negativization can be obtained within five years in more than 70% of children treated, this rate only reaches about 30% in adult patients after roughly 20 years of follow-up ( Figure 10) [48,101,102,103,104].…”

“…Age has been identified as an important predictor of cure; anti-parasitic treated children have higher rates and a prompter response to therapy than adults [98]. In addition, studies suggest a differential response to therapy depending on country of origin, suggesting variations in susceptibility to anti-parasitic agents depending on the parasite strain.…”

Purification of Glycosylphosphatidylinositol-Anchored Mucins from Trypanosoma cruzi Trypomastigotes and Synthesis of α-Gal-Containing Neoglycoproteins: Application as Biomarkers for Reliable Diagnosis and Early Assessment of Chemotherapeutic Outcomes of Chagas Disease

“…Unfortunately, the chemotherapy with these drugs is also associated with severe side effects, which may result in the discontinuation of the treatment in 10-20% of the patients [6,7]. Moreover, negative seroconversion using conventional serology following chemotherapy takes approximately 10-20 years to occur, which is a very poor prognostic perspective to support the widespread treatment of chronic ChD [8,9]. Due to these reasons, it is estimated that about 1% or less of chronic patients undergo treatment [10,11].…”