Sunday, 10 June 2012

The New HIV/AIDS of the Americas

Chagas: Is tropical disease really the new AIDS?

Chagas, a tropical disease spread by insects, is causing some fresh concern following an editorial—published earlier this week in a medical journal—that called it "the new AIDS of the Americas."

More than 8 million people have been infected by Chagas, most of them in Latin and Central America. But more than 300,000 live in the United States.

The editorial, published by the Public Library of Science's Neglected Tropical Diseases, said the spread of the disease is reminiscent of the early years of HIV.

"There are a number of striking similarities between people living with Chagas disease and people living with HIV/AIDS," the authors wrote, "particularly for those with HIV/AIDS who contracted the disease in the first two decades of the HIV/AIDS epidemic."

Both diseases disproportionately affect people living in poverty, both are chronic conditions requiring prolonged, expensive treatment, and as with patients in the first two decades of the HIV/AIDS epidemic, "most patients with Chagas disease do not have access to health care facilities. 

Stubborn Infection, Spread by Insects, Is Called ‘The New AIDS of the Americas’

Chagas disease, caused by parasites transmitted to humans by blood-sucking insects, has been named “the new AIDS of the Americas” in a lengthy editorial published in PLoS Neglected Tropical Diseases

The authors, several of whom are tropical disease experts from Baylor College of Medicine in Houston, argue that the dangerous spread of Chagas through this hemisphere somewhat resembles the early spread of H.I.V.

Chagas is also known as American trypanosomiasis, because the bugs carry single-celled parasites called trypanosomes. (Their best-known relative, spread by tsetse flies in Africa, causes sleeping sickness.)

Like AIDS, the authors say, Chagas disease has a long incubation time and is hard or impossible to cure. Chagas infects up to eight million people in the hemisphere, mostly in Bolivia, Mexico, Colombia and Central America. But more than 300,000 of the infected live in the United States, many of them immigrants.

The disease can be transmitted from mother to child or by blood transfusion. About a quarter of its victims eventually will develop enlarged hearts or intestines, which can fail or burst, causing sudden death. Treatment involves harsh drugs taken for up to three months and works only if the disease is caught early. 

Endemic Chagas disease has emerged as an important health disparity in the Americas 

As a result, we face a situation in both Latin America and the US that bears a resemblance to the early years of the HIV/AIDS pandemic. 

Neglected tropical diseases (NTDs) are among the most common conditions afflicting the estimated 99 million people who live on less than US$2 per day in the Latin American and Caribbean (LAC) region [1]. Almost all of the “bottom 100 million” living in the Americas suffer from at least one NTD [1], and according to some estimates, the NTDs cause a burden of disease in the LAC region that closely approximates or even exceeds that resulting from HIV/AIDS [2]. Chagas disease (American trypanosomiasis) is a vector-borne disease and a leading cause of the deaths and disability-adjusted life years (DALYs) lost that result from NTDs in the LAC region [2].

With approximately 10 million people living with Chagas disease, this condition is one of the most common NTDs affecting the bottom 100 million in the region, a prevalence exceeded only by hookworm and other soil-transmitted helminth infections [1], [2]. Moreover, among the NTDs in the Americas, Chagas disease ranks near the top in terms of annual deaths and DALYs lost [1], [2].

While most of the world's cases of Chagas disease occur in the LAC region, there is increasing recognition that many people with Trypanosoma cruzi infection also live in the US and Europe [3]. In practical terms, the “globalization” of Chagas translates to up to 1 million cases in the US alone, with an especially high burden of disease in Texas and along the Gulf coast [4], [5], although other estimates suggest that there are approximately 300,000 cases in the US [6], in addition to thousands of cases documented in Canada, Europe, Australia, and Japan [3].

Among those living with Chagas disease around the world today, 20%–30% (roughly 2–3 million people) are either currently suffering from Chagasic cardiomyopathy or will develop this clinical sequela [7]. Chagasic cardiomyopathy is a highly debilitating condition characterized by cardiac arrhythmias, heart failure, and risk of sudden death from ventricular fibrillation or tachycardia or thromboembolic events [7]. Another estimate suggests that up to 5.4 million people living today will develop Chagasic cardiomyopathy [8], [9]. Damage to the gastrointestinal tract can also produce debilitating megaesophagus and megacolon 

 Chagas: The Scary Disease Some Are Calling the New AIDS

Just when it seemed like all the super scary diseases had been discovered—flesh-eating bacteria, brain tapeworms, and, of course, HIV/AIDS, among many others—a new one comes along to bring fresh terror into our hearts. Introducing Chagas disease, which is caused by parasites that get into our bodies by way of blood-sucking insects. Ick.

As for what it does, about one quarter of people who have it develop enlarged hearts or intestines which can eventually fail—or worse, burst—leading to death. Gaaah. Naturally, it's very difficult to treat and is normally only curable if caught early.

Several tropical disease specialists recently published an editorial in PLoS Neglected Tropical Diseases (sounds like a fun read) in which they called Chagas, "the new AIDS of the Americas." They say the way it's spreading throughout this hemisphere is similar to the way that AIDS spread early on, and the disease itself shares some characteristics with HIV/AIDS.

For one thing, it's got a very long incubation period, and there's also the difficultly involved in curing it. Besides being transmitted by bugs, infection can be passed from mother to child and also by blood transfusion. It's estimated that there about eight million people in this hemisphere with Chagas. It's concentrated mostly in Bolivia, Mexico, Colombia, and Central America. However there are more than 300,000 cases in the United States, and most of the people infected here are immigrants. 

Coming soon: An over-the-counter HIV test? 

The FDA takes a step toward approving the first at-home kit to detect the virus. How important will this be in the battle against AIDS?

In a potentially huge step in the fight against AIDS, the advisory committee for the Food and Drug Administration has unanimously voted to recommend approval for the first over-the-counter HIV test. Carl Schmid, deputy director of the AIDS Institute, said the kit — the OraQuick In-Home HIV Test — could be a "game-changer."

Could this really prove effective in preventing the transmission of AIDS? Here, a concise guide to this potential breakthrough: 

How does the test work? 

It's simple. If the kit gets final approval, you'll be able to pick one up at the local drug store. To take the test, the user takes a mouth swab, collecting fluid to be checked for the HIV virus. The result is ready in 20 minutes

U.S. HIV aid has prevented 741,000 deaths: study

NEW YORK (Reuters Health) - The United States foreign aid program that sends billions of dollars to African countries for HIV treatment and prevention has cut the number of people dying for any reason in those nations, a new study suggests.

Researchers had previously shown that the initiative -- the U.S. President's Emergency Plan for AIDS Relief, or PEPFAR -- had prevented deaths from AIDS. But it was unclear if more people in those countries were only dying of tuberculosis or malaria instead, researchers explained.

According to the new findings, about 741,000 deaths were averted in 2004 through 2008 in the 12 African countries with PEPFAR programs, such as Ethiopia, Kenya and Uganda.

"There were concerns that there's been this shift in physicians and nurses (toward HIV clinics) to the detriment of other public health concerns," said lead researcher Dr. Eran Bendavid, an infectious diseases specialist from Stanford University in California. 

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