History, Current Issues and Future of the Brazilian Network for Attending and Studying Trypanosoma cruzi/HIV Coinfection

Abstract

Introduction: In countries with endemic Chagas disease, coinfection involving Trypanosoma cruzi and HIV is expected to become more frequent. There is a clear need to structure a comprehensive care network aimed at dealing with this situation, with mobilization going from primary care to care at the highest level of technological complexity. The objective of this study was to describe the Brazilian response to the challenges of Chagas disease: the history, current issues, and future of the Brazilian Network for attending and studying T. cruzi/HIV coinfection. Methodology: This descriptive study reviewed technical documents relating to the basis and structuring process of the Brazilian network for attending and studying T. cruzi/HIV coinfection. Results: The process of setting up the network was marked by technical and political debates in technical-scientific meetings going back to the 1990s. This process made it possible to expand and focus on different aspects of comprehensive care for Chagas disease in Brazil, regardless of the associated immunosuppressive conditions. These meetings produced a structure of national technical guidelines and standards, health care and research protocols and research priorities, along with mobilization and awareness-raising among HIV/AIDS reference centers regarding occurrences of coinfection. Conclusions: The creation of the Brazilian network was a milestone for the country in terms of integration of control programs, with the reference point of quality of care and comprehensiveness. The possibility of extending this network to form a Latin American network is seen as a strategy for dealing more effectively with this condition.

Prevalence of Trypanosoma cruzi infection in a cohort of people living with HIV/AIDS from an urban area

“…In recent decades, the spread of HIV infection to rural areas and the movement of patients with CD to urbanized areas has increased the overlap of these diseases, effectively contributing to an increased occurrence of CD/HIV coinfection [7,8].…”

“…In recent decades, the spread of HIV infection to rural areas and the movement of patients with CD to urbanized areas has increased the overlapping of these diseases, effectively contributing to an increased occurrence of CD/HIV co-infection [ 7 , 8 ]. Despite the recommendation to screen for T. cruzi infection in all PLWHA from endemic areas, there is a lack of information on the real prevalence of CD/HIV co-infection.…”

“…It has also been observed in non-endemic regions, such as the USA, Europe, Oceania and Asia due to migratory movements [4][5][6]. The extensive process of rural exodus in Latin America accentuates exposure to different comorbidities, and overlap between CD and HIV increases the number of coinfections [7,8]. Chagas disease reactivation has been observed in approximately 20% of those coinfected [8][9][10][11] as an opportunistic infection increasing mortality rate.…”

“…The extensive process of rural exodus in Latin America accentuates exposure to different comorbidities, and overlap between CD and HIV increases the number of coinfections [7,8]. Chagas disease reactivation has been observed in approximately 20% of those coinfected [8][9][10][11] as an opportunistic infection increasing mortality rate. In endemic areas of Latin America, the rate of CD/ HIV patient coinfection is estimated to be between 1.3% and 27.6% [12][13][14].…”