Data from: Quantitative PCR as a marker for preemptive therapy and its role in therapeutic control in Trypanosoma cruzi/HIV coinfection
Data files
Jan 15, 2024 version files 48.23 KB
Abstract
Background: Trypanosoma cruzi and HIV coinfection can evolve with depression of cellular immunity and increased parasitemia. We applied quantitative PCR (qPCR) as a marker for preemptive antiparasitic treatment to avoid fatal Chagas disease reactivation and analyzed the outcome of treated cases.
Methodology: This mixed cross-sectional and longitudinal study included 171 Chagas disease patients, 60 coinfected with HIV. Of these 60 patients, ten showed Chagas disease reactivation, confirmed by parasites identified in the blood, cerebrospinal fluid, or tissues, 12 exhibited high parasitemia but no reactivation, and 38 had low parasitemia and no reactivation.
Results: We showed, for the first time, the success of the timely introduction of benznidazole in the non-reactivated group with high levels of parasitemia detected by qPCR and the absence of parasites in reactivated cases with at least 58 days of benznidazole. HIV+ and HIV+ without reactivation had a 4.0 – 5.1 higher chance of having parasitemia than HIV seronegative cases. A positive correlation was found between parasite and viral loads. Remarkably, treated T. cruzi/HIV-coinfected patients had 77.3% conversion from positive to negative parasitemia compared to 19.1% of untreated patients. Additionally, untreated patients showed ~13.6 times higher odds of having positive parasitemia in the follow-up period compared with treated patients. Treated and untreated patients showed no differences regarding the evolution of Chagas disease. The main factors associated with all-cause mortality were higher parasitemia, lower CD4 counts/µL, higher viral load, and absence of antiretroviral therapy.
Conclusion: We recommend qPCR prospective monitoring of T. cruzi parasitemia in HIV+ patients and point out the value of pre-emptive therapy for patients with temporary high parasitemia. In parallel, an early antiretroviral therapy introduction is advisable, aiming at viral load control, immune response restoration, and major survival. We also suggest an earlier antiparasitic treatment for all coinfected patients, followed by effectiveness analysis alongside antiretroviral therapy.
README: Data from: Quantitative PCR as a marker for preemptive therapy and its role in therapeutic control in Trypanosoma cruzi//HIV coinfection.
https://doi.org/10.5061/dryad.05qfttf8f
A positive correlation was found between parasites and viral loads. Remarkably, treated *T. cruzi/*HIV-coinfected patients had 77.3% conversion from positive to negative parasitemia compared to 19.1% of untreated patients. In addition, untreated patients showed ~13.6 times higher odds of having positive parasitemia in the follow-up period compared with treated patients. There were no statistically significant differences between treated and untreated patients regarding the evolution of Chagas disease. The main factors associated with all-cause deaths were higher parasitemia, lower CD4 counts/µL, higher viral load, and absence of antiretroviral therapy.
Description of the data and file structure
The study included 171 patients with *T. cruzi *infection: 60 HIV-coinfected (HIV+) and 111 HIV seronegative, as comparator groups. All sociodemographic, clinical, and laboratory data, date of therapy and, sample collections (before treatment and during follow-up), results of parasitemia (parasitological and molecular methods), CD4 counts, HIV viral loads, antiretroviral therapy and schemes, the evolution of Chagas disease, all-cause mortality and deaths due to Chagas disease, were collected by accessing the Medical records, and organized in an excel spreadsheet.
The meaning of the variables is described in the following table:
| Row | Definition |
|---|---|
| A | Identification |
| B | Chagas Disease patients with (Yes) or witlhout co-infection HIV (No) |
| C | Native to which region of Brazil |
| D | Sex; Male=0, Female=1 |
| E | Missing - Information not available |
| F | 2 - Information not available |
| G | Cardiac Form of CD: Cardiac involvement and Cardiac + Digestive involvement; 2 - Information not available |
| H | Digestive Form of CD: Digestive involvement and Digestive + Cardiac involvement; 2 - Information not available |
| I | Indeterminated Form of CD: Patients without signals or symptoms and without Electrocardiogram changes, normal cardiac area and no digestive involvement; 2 - Information not available |
| J | Date in quarter/year of the 1st sample collected intended for testing to detect T. cruzi using direct parasitological (QBC; microhematocrit, histopathology), indirect parasitological (blood culture and xenodiagnosis), and molecular tests (conventional and quantitative PCR) and/or 1st clinical evaluation of the patient. |
| K | Reactivation of chronic Chagas disease is a rare condition and occurs only in immunosuppressed patients. This condition is diagnosed by the detection of T. cruzi by direct parasitological tests: QBC, Microhematocrit, Strout, histopathological. |
| L | Site of manifestation of Chagas disease reactivation. |
| M | cPCR T0: Conventional PCR referring to the 1st sample collected. Results presented as Positive or Negative. |
| N | qPCR, Par Eq/ml of blood, T0, (Log10): Quantitative PCR, results presented as log10 (equivalent value of T. cruzi/mL of blood collected +1), referring to the 1st sample collected. |
| O | Indirect Parasitilogical Test: blood culture and xenodiagnosis results of 1st sample collected. Results presented as Positive or Negative |
| P | Parasitemia: parasitological indirect (blood culture and xenodiagnosis) and/or molecular tests (conventional and quantitative PCR, referring to the 1st sample collected. Results presented as Positive or Negative |
| Q | Patients with reactivation of Chagas disease or those not reactivated who presented high levels of parasitemia, assessed by quantitative xenodiagnosis, associated with clinical worsening of Chagas disease were treated with Benzonidazole. |
| R | CD4* count cells/µL T0 = T CD4 cell count in HIV+ patients. Results presented as number of cells/ul |
| S | Viral Load count RNA viral copies*/µL T0 = RNA viral copies in HIV+ patients. Results presented as number of RNA viral copies*/µL. |
| T | ART- T0: Use of antiretroviral therapy before and during the collection of the first sample |
| U | ART class: Class of antiretroviral therapy used |
| V | Date in quarter/year of the 2nd sample collected intended for testing to detect T. cruzi using direct parasitological tests (QBC; microhematocrit, histopathology), indirect (blood culture and xenodiagnosis), and molecular tests (conventional and quantitative PCR) |
| W | cPCR T1:Conventional PCR referring to the 2nd sample collected. Results presented as Positive or Negative |
| X | qPCR, Par Eq/ml of blood, T1, (Log10): Quantitative PCR, results presented as log10 (equivalent value of T cruzi/mL of blood collected +1), referring to the 2nd sample collected |
| Y | Indirect Parasitilogical Test: blood culture and xenodiagnosis results of 2nd sample collected. Results presented as Positive or Negative |
| Z | Parasitemia: parasitological indirect (blood culture and xenodiagnosis) and/or molecular tests (conventional and quantitative PCR), referring to the 2nd sample collected. Results presented as Positive or Negative |
| AA | CD4* count cells/µL T0 = T CD4 cell count in HIV+ patients, referring to the 2nd sample collected. Results presented as number of cells/ul |
| AB | Viral Load count RNA viral copies*/µL T0 = RNA viral copies in HIV+ patients, referring to the 2nd sample collected. Results presented as number of RNA viral copies*/µL. |
| AC | CD Clinical Worsening: Clinical worsening of Chagas disease during follow-up is characterized by evolution to more severe disease in the same clinical form or evolution to another clinical form or death. |
| AD | Non-immunosuppressed patients with chronic Chagas disease were referred for follow-up in basic health units, which leads to loss of information. |
| AE | Date in quarter/year of the dead. |
Methods
The mixed cross-sectional and longitudinal study included 171 patients with T. cruzi infection: 60 HIV-coinfected (HIV+) and 111 HIV seronegative, as comparator groups. Most of them recruited from the Infectious and Parasitic Diseases Division of the Hospital das Clínicas, a tertiary hospital adjacent to the School of Medicine of the University of São Paulo, Brazil. All sociodemographic, clinical, and laboratory data, date of treatment and sample collections (before treatment and during follow-up), results of parasitemia (parasitological and molecular methods), CD4 counts, HIV viral loads, antiretroviral therapy and schemes, the evolution of Chagas disease, all-cause mortality and deaths due to Chagas disease, were collected by accessing the Medical records.