title: Towards a paradigm shift in the treatment of chronic Chagas disease.
abstract: Treatment for Chagas disease with currently available medications is recommended universally only for acute cases (all ages) and for children up to 14 years old. The World Health Organization, however, also recommends specific antiparasite treatment for all chronic-phase Trypanosoma cruzi-infected individuals, even though in current medical practice this remains controversial, and most physicians only prescribe palliative treatment for adult Chagas patients with dilated cardiomyopathy. The present opinion, prepared by members of the NHEPACHA network (Nuevas Herramientas para el Diagnóstico y la Evaluación del Paciente con Enfermedad de Chagas/New Tools for the Diagnosis and Evaluation of Chagas Disease Patients), reviews the paradigm shift based on clinical and immunological evidence and argues in favor of antiparasitic treatment for all chronic patients. We review the tools needed to monitor therapeutic efficacy and the potential criteria for evaluation of treatment efficacy beyond parasitological cure. Etiological treatment should now be mandatory for all adult chronic Chagas disease patients.
authors.affiliation: Hospital Interzonal General de Agudos (HIGA) Eva Perón, Sección Chagas, Servicio de Cardiología, Buenos Aires, Argentina.
authors.forename: R
authors.initials: R
authors.lastname: Viotti
authors.forename: B
authors.initials: B
authors.lastname: Alarcón de Noya
authors.forename: T
authors.initials: T
authors.lastname: Araujo-Jorge
authors.forename: M J
authors.initials: MJ
authors.lastname: Grijalva
authors.forename: F
authors.initials: F
authors.lastname: Guhl
authors.forename: M C
authors.initials: MC
authors.lastname: López
authors.forename: J M
authors.initials: JM
authors.lastname: Ramsey
authors.forename: I
authors.initials: I
authors.lastname: Ribeiro
authors.forename: A G
authors.initials: AG
authors.lastname: Schijman
authors.forename: S
authors.initials: S
authors.lastname: Sosa-Estani
authors.forename: F
authors.initials: F
authors.lastname: Torrico
authors.forename: J
authors.initials: J
authors.lastname: Gascon
mesh_terms: D000293:Adolescent; D000328:Adult; D000913:Antibodies, Protozoan / Q000097:blood; D002598:Chagas Cardiomyopathy / Q000188:drug therapy* / Q000276:immunology / Q000469:parasitology / Q000473:pathology; D002648:Child; D002908:Chronic Disease; D019468:Disease Management; D004334:Drug Administration Schedule; D006801:Humans; D009547:Nifurtimox / Q000627:therapeutic use*; D009593:Nitroimidazoles / Q000627:therapeutic use*; D017410:Practice Guidelines as Topic; D016032:Randomized Controlled Trials as Topic; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014344:Trypanocidal Agents / Q000627:therapeutic use*; D014349:Trypanosoma cruzi / Q000187:drug effects / Q000472:pathogenicity / Q000502:physiology
chemical_list: D000913:Antibodies, Protozoan; D009593:Nitroimidazoles; D014344:Trypanocidal Agents; D009547:Nifurtimox; C009999:benzonidazole