Coinfecção Trypanosoma cruzi/HIV e reativação da Doença de Chagas em uma coorte submetida à avaliação parasitológica entre 1995 e 2019 no Hospital de Clínicas da Universidade Federal do Triângulo Mineiro, Uberaba/Minas Gerais

Abstract

Trypanosoma cruzi is the etiologic agent of Chagas disease that occurs between 6 and 8 million people, most of them in Latin America. Human Immunodeficiency Syndrome / AIDS or Acquired Immune Deficiency Syndrome / AIDS is a chronic degenerative infection currently detected in 38 million people and caused by human immunodeficiency viruses 1 (HIV-1) and 2 (HIV-2). The spread of HIV in endemic regions for Chagas disease generated the Trypanosoma cruzi / HIV coinfection. In this study, the profile of Chagas disease reactivation was evaluated in a cohort of individuals with the Trypanosoma cruzi / HIV coinfection detected among chagasic individuals who underwent parasitological examinations for the detection of Trypanosoma cruzi at the Hospital de Clínicas da UFTM / Uberaba / Minas Gerais between 1995 and 2019. Coinfection was identified in 6.6% (99/1501) of these individuals, who had a mean age of 51.6 ± 10.5 years, with no difference in terms of gender and age (p>0.05). These came mainly from the states of Minas Gerais (64.6%) and São Paulo (24.2%). In the group of coinfected individuals, there was no significant difference between the means of LT-CD4+ in males and females (p=0.17), however, the viral load was lower in males (p=0.0208). Chagas disease reactivation occurred in 23.2% (23/99) of the individuals, with a reactivation rate of 24.2% (24/99), 2 reactivations / 1 case. The parasite was detected in blood in 54.2%, in blood and cerebrospinal fluid in 29.1%, and cerebrospinal fluid in 16.7%. Among the reactivated individuals, there was no difference between the distribution according to gender (p> 0.05) and mean age, however, the non-reactivated, presented a higher mean age (p=0.024). The mortality rate was higher (p=0.0050) in the group with reactivation and was associated with invasion of the central nervous system in 71.4% of cases, in females (p=0.0017), LT-CD4+ < 200 cells/mm3 and higher viral load. The LT-CD4+ count in the non-reactivated group was higher compared to the reactivated group (p= 0.0186). The distribution of viral load between individuals with reactivation and without reactivation showed no difference, however, the p-value was at the threshold of significance (p=0.0510). Regarding the distribution by gender, it was found that the average of LT-CD4+ in the reactivated group was lower (p=0.0109) in the male gender, with no difference (p>0.05) in viral load. In the non-reactivated group, the mean LTCD4+ did not differ between genders (p=0.4480), however, the viral load was lower in males (p=0.0462). Coinfected individuals had 47.3% of blood culture samples positive, associated with higher viral load and lower LT-CD4+ count (p<0.0001), and negative ones with higher levels of LT-CD4+ and lower viral load. Blood culture positivity was higher (p=0.0008) among samples from reactivated individuals (63.1%) than among non-reactivated individuals (40.9%), the reactivated group had lower LT-CD4+ and higher viral load than the non-reactivated. In Trypanosoma cruzi / HIV coinfection, three profiles of Chagas disease reactivation were identified according to LT-CD4+ values and viral load: Group A: without immunosuppression (LT-CD4+ > 204 cells/mm3) and low/ moderate viral load; Group B: immunosuppression (LT-CD4+ ≤ 215 cells/mm3) and high viral load; Group C: immunosuppression (LT-CD4+ < 200 cells/mm3) and low/moderate viral load. The data found open new perspectives for better classification and monitoring of disease reactivation in Trypanosoma cruzi / HIVAIDS coinfection.