Chronic Chagas cardiomyopathy: a review of the main pathogenic mechanisms and the efficacy of aetiological treatment following the BENznidazole Evaluation for Interrupting Trypanosomiasis (BENEFIT) trial

• Main Authors: Anis Rassi Jr, José Antonio Marin Neto, Anis Rassi
• Format: Article
• Language: English
• Published: Instituto Oswaldo Cruz, Ministério da Saúde
• Series: Memórias do Instituto Oswaldo Cruz.
• Subjects: chronic Chagas cardiomyopathy; Chagas heart disease; pathogenesis; aetiological treatment; Benznidazole; BENEFIT trial
• Online Access: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0074-02762017000300224&lng=en&tlng=en

Chagas cardiomyopathy is the most frequent and most severe manifestation of chronic Chagas disease, and is one of the leading causes of morbidity and death in Latin America. Although the pathogenesis of Chagas cardiomyopathy is incompletely understood, it may involve several mechanisms, including parasite-dependent myocardial damage, immune-mediated myocardial injury (induced by the parasite itself and by self-antigens), and microvascular and neurogenic disturbances. In the past three decades, a consensus has emerged that parasite persistence is crucial to the development and progression of Chagas cardiomyopathy. In this context, antiparasitic treatment in the chronic phase of Chagas disease could prevent complications related to the disease. However, according to the results of the BENEFIT trial, benznidazole seems to have no benefit for arresting disease progression in patients with chronic Chagas cardiomyopathy. In this review, we give an update on the main pathogenic mechanisms of Chagas disease, and re-examine and discuss the results of the BENEFIT trial, together with its limitations and implications.