Screening for Trypanosoma cruzi in patients living with the human immunodeficiency virus (PWH) in the Peruvian Amazon

Abstract

Introduction: Chagas disease (CD) - Trypanosoma cruzi infection - in people living with HIV (PWH), particularly those with advanced CD4 T cell depletion, can lead to severe syndromes affecting the central nervous system and the heart. Methods: We performed a cross-sectional study to screen for CD among PWH in Iquitos, Peru, between October 2023 and May 2024, with the objective of understanding the frequency of infection in this population. Adults with confirmed HIV attending outpatient services at two regional hospitals were enrolled. Two ELISA tests (lysate and recombinant) were used, and discordant results were adjudicated by indirect chemiluminescence immunoassay (CLIA). Result: Of 534 PWH, the median age was 41 years (IQR 32-49), 66.1 % were male, the median current CD4+ count was 443/μL, and 75.8 % had an undetectable viral load. Two discordant serologic results were resolved with a negative CLIA, resulting in no confirmed CD cases. Conclusion: The prevalence of T. cruzi infection is likely very low in urban and peri-urban areas of Iquitos. Continued epidemiological surveillance is essential to monitor potential changes over time.