Chagas Disease in Immunosuppressed Patients

Abstract

This chapter is a brief update on immunosuppression and Chagas disease (CD) and refers to the pharmacological immunosuppression in solid organ transplantation and hematopoietic stem cell transplantation and to the biological immunosuppression induced by the human immunodeficiency virus (HIV). In transplantation a review is made of historical and current immunosuppressive drugs and of the keys in the diagnosis for recipients and donors with Chagas disease and their management during the follow-up after transplantation. Likewise, the main events published in the different heart, kidney, liver, and bone marrow transplants in Chagas disease in endemic and non-endemic countries are described. The events corresponding to non-endemic countries have been published, due to the intense migratory flow from the endemic countries to the non-endemic (developed) countries in Europe, Canada, Australia, and the United States. This chapter also covers published reports of the main transplants, key situations in the diagnosis, as well as conclusions. In HIV and Chagas, a historical review is made since the appearance of AIDS in the world and its characterization as a pandemic. The great and rapid advances in the research of AIDS are a paradigm on how to make progress in order to control a disease. The appearance of new treatments meant a change in the clinical profile and a change in the life expectancy of AIDS patients. With respect to Chagas disease and AIDS, the reactivation of CD in AIDS patients constitutes an AIDS-defining event. This chapter presents different clinical CD-AIDS scenarios, the diagnosis and treatment, as well as a vision of the future.