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Commentary

Towards a Paradigm Shift in the Treatment of Chronic Chagas Disease

R. Viotti, B. Alarcón de Noya, T. Araujo-Jorge, M. J. Grijalva, F. Guhl, M. C. López, J. M. Ramsey, I. Ribeiro, A. G. Schijman, S. Sosa-Estani, F. Torrico, J. Gascon
and on behalf of the Latin American Network for Chagas Disease, NHEPACHA
R. Viotti
Hospital Interzonal General de Agudos (HIGA) Eva Perón, Sección Chagas, Servicio de Cardiología, Buenos Aires, Argentina
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B. Alarcón de Noya
Instituto de Medicina Tropical, Universidad Central de Venezuela (IMT-UCV), Caracas, Venezuela
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T. Araujo-Jorge
Fundação Oswaldo Cruz—Instituto Oswaldo Cruz (FIOCRUZ-IOC), Programa Integrado de Doença de Chagas, Laboratório de Inovações em Terapias, Ensino e Bioprodutos, Río de Janeiro, Brazil
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M. J. Grijalva
Centro de Investigación de Enfermedades Infecciosas de la Pontificia Universidad Católica del Ecuador (CIEI-PUCE), Quito, Ecuador, and Tropical Disease Institute, Ohio University (TDI-OU), Athens, Ohio, USA
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F. Guhl
Centro de Investigaciones en Microbiología y Parasitología Tropical, Universidad de los Andes (UA-CIMPAT), Bogotá, Colombia
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M. C. López
Instituto de Parasitología y Biomedicina Lopez-Neyra-Consejo Superior de Investigaciones Científicas (IPBLN-CSIC), Granada, Spain
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J. M. Ramsey
Centro Regional de Investigación en Salud Pública, Instituto Nacional de Salud Pública (CRISP-INSP), Tapachula, Chiapas, Mexico
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I. Ribeiro
Drugs for Neglected Diseases Initiative (DNDi), Geneva, Switzerland
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A. G. Schijman
Instituto de Investigaciones en Ingeniería Genética y Biología Molecular (INGEBI), CONICET, Buenos Aires, Argentina
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S. Sosa-Estani
Instituto Nacional de Parasitología Dr. Mario Fatala Chaben (INP)-ANLIS Dr. Carlos G. Malbran, Buenos Aires, Argentina
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F. Torrico
Universidad Mayor de San Simón (UMSS), Cochabamba, Bolivia
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J. Gascon
Barcelona Center for International Health Research (CRESIB), Hospital Clinic/IDIBAPS, Barcelona, Spain
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DOI: 10.1128/AAC.01662-13
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    FIG 1

    Comparison of concepts belonging to the old and the new paradigms for chronic Chagas disease. Relevant references are given in parentheses.

Tables

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  • TABLE 1

    Results of nonrandomized studies with etiological treatment for patients with chronic Chagas disease, showing the relationship between clinical and serological evolutiona

    1st author, yr (reference)No. of patients:No. of patients (treated/not treated) that had:% of patients:
    TreatedNot treatedEKG changesProgression of cardiomyopathyWith reduction of risk progressionNegative for seroconversion
    TreatedNot treated
    Viotti, 1994 (33)131700/42/1788196
    Gallerano, 2000 (35)53566814/344/18785Data not available
    Viotti, 2006 (37)2832835/164/1471156
    Fabbro De Suasnábar, 2000 (34)54574/167537Data not available
    Avg6/173/1678196
    • ↵a Treatment was with benznidazole except for reference 35, which reports on 309 patients treated with alopurinol, 130 treated with benznidazole, and 96 treated with nifurtimox.

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Towards a Paradigm Shift in the Treatment of Chronic Chagas Disease
R. Viotti, B. Alarcón de Noya, T. Araujo-Jorge, M. J. Grijalva, F. Guhl, M. C. López, J. M. Ramsey, I. Ribeiro, A. G. Schijman, S. Sosa-Estani, F. Torrico, J. Gascon on behalf of the Latin American Network for Chagas Disease, NHEPACHA
Antimicrobial Agents and Chemotherapy Jan 2014, 58 (2) 635-639; DOI: 10.1128/AAC.01662-13

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Towards a Paradigm Shift in the Treatment of Chronic Chagas Disease
R. Viotti, B. Alarcón de Noya, T. Araujo-Jorge, M. J. Grijalva, F. Guhl, M. C. López, J. M. Ramsey, I. Ribeiro, A. G. Schijman, S. Sosa-Estani, F. Torrico, J. Gascon on behalf of the Latin American Network for Chagas Disease, NHEPACHA
Antimicrobial Agents and Chemotherapy Jan 2014, 58 (2) 635-639; DOI: 10.1128/AAC.01662-13
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    • ABSTRACT
    • TEXT
    • PATHOGENESIS OF CHRONIC CHAGAS DISEASE: CHRONIC PERSISTENCE OF THE PARASITE?
    • WHAT IS CONSIDERED EFFICACY: A LOWER PARASITE BURDEN OR PARASITE CLEARANCE?
    • TREATMENT MONITORING
    • ADVERSE EFFECTS OF ANTIPARASITIC TREATMENT
    • CONCLUSIONS
    • ACKNOWLEDGMENT
    • FOOTNOTES
    • REFERENCES
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