Parasite load evaluation by qPCR and blood culture in Chagas disease and HIV co-infected patients under antiretroviral therapy

Gláucia Elisete Barbosa Marcon; Juliana de Jesus Guimarães Ferreira; Eros Antonio de Almeida; Adriane Maira Delicio; Mariane Barroso Pereira; Jamiro da Silva Wanderley; Luiz Cláudio Martins; Paula Durante Andrade; Rodrigo Gonçalves de Lima; Sandra Cecília Botelho Costa

doi:10.1371/journal.pntd.0010317

Parasite load evaluation by qPCR and blood culture in Chagas disease and HIV co-infected patients under antiretroviral therapy

PLoS Negl Trop Dis. 2022 Mar 30;16(3):e0010317. doi: 10.1371/journal.pntd.0010317. eCollection 2022 Mar.

Affiliations

¹ Fundação Oswaldo Cruz; Campo Grande, Mato Grosso do Sul, Brazil.
² Laboratório de Diagnóstico de Doenças Infecciosas por Técnicas de Biologia Molecular, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, São Paulo, Brazil.
³ Departamento de Clínica Médica, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, São Paulo, Brazil.

Abstract

Chagas disease also known as American trypanosomiasis, is caused by Trypanosoma cruzi and transmitted by triatominae-contaminated feces. It is considered a neglected tropical disease that affects 6 to 7 million people worldwide. The reactivation of Chagas disease occurs when the chronically infected hosts are not able to control T. cruzi infection, generating recurrence of the acute phase. HIV is the main immunosuppressive infection that can lead to the reactivation of chronic Chagas disease in AIDS conditions. In co-infected patients, the reactivation of Chagas disease is related to their high parasite load, high HIV viral load, and CD4 T-cell counting less than 200/mm3, which may evolve to meningoencephalitis and myocarditis. Eight T. cruzi/HIV co-infected patients under antiretroviral therapy (ART) and ten Chagas disease patients without HIV infection that attended at Study Group of Chagas Disease, Hospital de Clínicas, University of Campinas (GEdoCh/HC/UNICAMP-SP) and Pontifical Catholic University of Campinas SP (PUCC/SP) were evaluated. Tests for Chagas disease were performed, such as qPCR and T. cruzi blood culture. The patient's medical records were analyzed to verify clinical and epidemiological data, viral load, and CD4 T-cell counting since the outset of ART. For both groups, we found no statically significant differences between parasite load via blood culture and qPCR. In T. cruzi/HIV co-infected subjects, we observed a significant increase of CD4 T-cells counting and viral load decrease, which became undetectable over the years after ART. Parasites isolated from the patient's blood culture were genotyped, being the majority of them infected with TcII and one case of mixed infection (TcII and TcV/TcVI). These results were expected according to the region of origin of the patients. We suggest that the parasite load be monitored through qPCR in T.cruzi/HIV co-infected patients. We conclude that ART in people living with HIV improves infection and immunosuppression control, enabling the natural evolution of the American trypanosomiasis.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Blood Culture
Chagas Disease* / complications
Chagas Disease* / drug therapy
Chagas Disease* / parasitology
Coinfection* / parasitology
HIV Infections* / complications
HIV Infections* / drug therapy
Humans
Parasite Load

Grants and funding

This study was funded by the Fundação de Amparo à Pesquisa do estado de São Paulo - FAPESP (grant 16/08737-0) to SCBC. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.