Reactivations of chronic Chagas disease and treatment of Chagas disease in immunosuppressed patients

Patients with chronic Chagas disease who acquire AIDS or in whom immunosup- pressor therapy is administered must receive treatment at the same dose as the group mentioned above for 5 or more months. In these cases the most

suitable strategy is prevention, performing serology for Chagas disease in all AIDS patients. In the primoinfection by T. cruzi in AIDS patients, the same treatment schedule must be prescribed as in reactivations. The same classic antiparasitic drugs are used in the standard doses until the immune response of the host is reconstituted (in some cases 60 or more days). Once the alteration of the immune system is normalized, including the ratio of CD4/CD8, the antiparasitic schedule is changed to every 3 days, balancing the parasiticide effects with the adverse effects. The patients with AIDS without retroviral treatment are the most severely affected. In these patient, once the CD4 levels are normalized with specific antiviral treatment, maintenance schedules may be used.