title: Management of Trypanosoma cruzi coinfection in HIV-positive individuals outside endemic areas.
abstract: OBJECTIVE
  Chagas disease has spread beyond the geographical barriers of the American continent in the past decade. Consequently, physicians treating HIV-infected patients in nonendemic countries have to face an opportunistic infection they have little experience with. This review examines the literature on Chagas disease in HIV-infected patients, with special emphasis on recent findings.
  
  
  RESULTS
  Although infection by Trypanosoma cruzi is a severe opportunistic infection in HIV-infected patients, awareness of this parasitosis in nonendemic countries remains low. Deeply immunosuppressed patients with chronic infection can develop reactivations, which can be very severe and are associated with high mortality. Reactivations mostly affect the central nervous system, followed by the heart, and diagnosis is based on the direct detection of the parasite or histology. There is no reliable method of predicting reactivations. Treatment is based on benzimidazoles, although neither the appropriate treatment schedule nor the need for secondary prophylaxis has been clearly established. Antiretroviral therapy seems to play a fundamental role in the prevention of reactivations and control of relapses; however, more information is needed.
  
  
  CONCLUSIONS
  Many aspects of T. cruzi-HIV coinfection remain uncertain. Until new data covering the current gaps become available, early diagnosis and prompt antiretroviral therapy seem to be fundamental for avoiding reactivations and improving late visceral involvement.
authors.forename: José A
authors.initials: JA
authors.lastname: Pérez-Molina
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D014355:Chagas Disease / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D002908:Chronic Disease; D060085:Coinfection / Q000175:diagnosis / Q000188:drug therapy; D019468:Disease Management; D019353:Endemic Diseases; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D014344:Trypanocidal Agents / Q000627:therapeutic use*; D014349:Trypanosoma cruzi
chemical_list: D019380:Anti-HIV Agents; D014344:Trypanocidal Agents