Is Chagas Disease Really The New AIDS Of The Americas?

This is the seventh of 16 student posts, guest-authored by Joshua Pikora.

Recently an article published in PLoS Neglected Tropical Diseases titled Chagas Disease: “The New HIV/AIDS of the Americas” caused a stir in the media receiving coverage through Fox News and The New York Times among others.  This article, as the title indicates, claims that Chagas disease is the new AIDS of the Americas and likens the current situation of Chagas disease to that of the first two decades of the AIDS epidemic, but is that truly the case¹?  The argument that I gained from the article is that the early decades of the AIDS epidemic and Chagas disease affected similar demographics of people, and that the current number of AIDS patients and Chagas disease patients with cardiomyopathy in the Americas are similar.  The argument that the populations are similar is that both diseases affected those living in poverty, that do not have access to medical care, and hidden populations homosexuals in the case of AIDS and immigrants in the case of Chagas¹.  Also the numbers of those living with AIDS and Chagas disease with cardiomyopathy cited in the article are similar with 2-5 million people with cardiomyopathy and roughly 3 million people with AIDS¹.  Additionally the article also argues that they are both chronic conditions, are expensive to treat and are stigmatizing¹.  While this is a compelling argument I believe that the differences between the two diseases outweigh these similarities, and these similarities alone do not warrant declaring Chagas disease the “new” AIDS.  In my opinion the article is well written, and puts together a case to support their claim, but while I do not mean to discredit the article, or to imply that Chagas disease is not a serious disease and should not be addressed, I disagree that it is as big of a problem as AIDS is, and was in the early decades of the epidemic.

Beyond simple differences between the disease like that Chagas disease is caused by a protozoan and AIDS is cause by a virus I have several problems with the claim that Chagas disease is the “new” AIDS of the Americas.  My first problem with the claim is that, in my opinion, in order for something to be the “new” AIDS, AIDS itself must be dealt with first, and as the article makes clear, AIDS is still a problem in the Americas with 1.6 million people living with AIDS in Latin America and the Caribbean, and 1.2 million living with AIDS in the US¹.   The second issue I have with the claim is that it includes North America.  The article states that 8-9 million people are living with Chagas disease in Latin America compared to 300,000 in the US, with most of them being immigrants and vector transmission being rare in the US^1,2.  While I would agree that Chagas disease is a serious problem in Lating America that needs more resources, I still would not compare it to AIDS as the two have very different levels of burden, and need to be addressed in different ways based on transmission.

The article does point out that Chagas disease and AIDS do share some modes of transmission, but they also have some unique modes as well.  Both AIDS and Chagas disease can be transmitted from mother to child vertically, and through blood transfusions¹.  However, according to the article the rate of vertical transmission of  Trypanosoma cruzi 5%-10% pales in comparison to that of untreated HIV which is 15%-40%, though the rates of vertical transmission of HIV when antiretrovirals are being used is only 1%-2%¹.  In the case of blood transfusions the US has screened for T. cruzi since 2007 and HIV since 1985 and blood banks in Latin America also screen for T. cruzi^2,3.  Though AIDS and Chagas disease do share these modes of transmission they also have vastly different modes.  Chagas disease is primarily a vector born disease, using triatomine bugs as vectors, with transmission occurring by the bug’s feces getting into the site where the bug bit the host².  There is also evidence of Chagas disease being transmitted through food contaminated with the feces of infected triatomine bugs¹.  On the other hand AIDS can be sexually transmitted, and can be transmitted by using needles that have been used by an infected person³.

The article does describe several ways in which AIDS and Chagas disease are different.  The first of these is based on the differences in morbidity and mortality between the two diseases.  The article cites that annual deaths and lose of DALYs in the Americas is five times greater for AIDS than it is for Chagas disease, which shows a clear gap between the two¹.  Another difference the article points out is that while AIDS is almost always fatal, only 20%-30% of people with Chagas disease will develop cardiomyopathy, displaying another gap between the diseases¹.  A third difference that the article states between Chagas disease and AIDS is the number of medications available for the diseases.  While there are no medications that cure AIDS there are a number of antiretrovirals available to use as treatment, whereas there are medications available that can cure Chagas disease if caught early these medications are few in number and are infective against the chronic form¹.  The amount of time that the medications need to be taken also differs between the diseases, with antiretrovirals being needed for life for AIDS patients, and medication for Chagas disease needing to be taken for one to three months¹.

While both AIDS and Chagas disease are serious disease and Chagas disease is a particularly important issue that needs to be addressed in Central and South America, I do not believe that it is appropriate to call Chagas disease the “new” Aids of the Americas or even of Latin America.  Whether the title of the article was a ploy for attention or an honest belief may never be known, but hopefully this media attention can increase the awareness of Chagas disease and efforts to contain it, without distracting from the still important issue of AIDS.

Works Cited

1. Hotez PJ, Dumonteil E, Woc-Colburn L, Serpa JA, Bezek S, et al. (2012) Chagas Disease: “The New HIV/AIDS of the Americas”. PLoS Negl Trop Dis 6(5): e1498.

2. Zieve, David. "Chagas Disease." Pubmed Health. U.S. National Library of Medicine, 15 Sept. 2010. Web. 17 June 2012. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002348/.

3.  Dugdale, David. "AIDS." Pubmed Health. U.S. National Library of Medicine, 9 June 2011. Web. 17 June 2012. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001620/.