For years, Aids was considered Africa’s disease—thanks to the stereotype among the Western media—for nearly three decades since the disease was first spotted in the continent, but today, the Western world is also devastated by 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.
So far the disease is yet to be discovered in Africa, but with daily migration of people between the continent, Europe and America, there possibilities that the new Aids could globally spread.
But, if the disease is a pro-poor as reported in America, this week, Africa—a continent still clouded by massive poverty—could be highly devastated if the ‘new Aids’ finally arrives on the continent.
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 Neglected Tropical Diseases(NTDs) in the Latin America and Caribbean (LAC) region.
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.
Moreover, among the NTDs in the Americas, Chagas disease ranks near the top in terms of annual deaths and DALYs lost.
While most of the world's cases of Chagas disease occur in the Latin America and Caribbean AC region, there is increasing recognition that many people with Trypanosome cruzi infection also live in the US and Europe. 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, although other estimates suggest that there are approximately 300,000 cases in the US, in addition to thousands of cases documented in Canada, Europe, Australia, and Japan.
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."
Unlike HIV, Chagas is not a sexually-transmitted disease: it's "caused by parasites transmitted to humans by blood-sucking insects," as the New York Times put it.
"It likes to bite you on the face," CNN reported. "It's called the kissing bug. When it ingests your blood, it excretes the parasite at the same time. When you wake up and scratch the itch, the parasite moves into the wound and you're infected."
Chagas, also known as American trypanosomiasis, kills about 20,000 people per year, the journal said.
And while just 20 percent of those infected with Chagas develop a life-threatening form of the disease, Chagas is "hard or impossible to cure," the Times reports:
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.
"The problem is once the heart symptoms start, which is the most dreaded complication—the Chagas cardiomyopathy—the medicines no longer work very well," Dr. Peter Hotez, a researcher at Baylor College of Medicine and one of the editorial's authors, told CNN. "Problem No. 2: the medicines are extremely toxic."
And 11 percent of pregnant women in Latin America are infected with Chagas, the journal said.
There are a number of striking similarities between people living with Chagas disease and people living with HIV/AIDS, particularly for those with HIV/AIDS who contracted the disease in the first two decades of the HIV/AIDS epidemic. Both diseases are health disparities, disproportionately affecting people living in poverty.
Both are chronic conditions requiring prolonged treatment courses: a lifetime of antiretroviral therapy for HIV/Aids patients, and one to three months of therapy for those with Chagas disease. Treatment for HIV/Aids is lifesaving, although it seldom if ever results in cure, while for Chagas disease, the treatment has proven efficacy only for the acute stages of the infection or in children up to 12 years of age during the early chronic phase of the infection.
For both diseases the treatment is expensive—in the case of Chagas disease, the expected cost of treatment per patient year is $1,028, with lifetime costs averaging $11,619 per patient . Exacerbating costs, Chagas disease itself is a serious opportunistic infection of people living with HIV/Aids, and is associated with meningoencephalitis, cerebral lesions, and high mortality 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.
A recent analysis indicates that many patients do not have access to the essential medicines for Chagas disease, in particular, the first line of therapy, the drug benznidazole.
According to Médecins Sans Frontières (MSF, Doctors Without Borders), many highly endemic countries, including Paraguay and Bolivia, face acute shortages of benznidazole, forcing thousands of newly diagnosed patients to postpone treatment.
Both diseases are also highly stigmatizing, a feature that for Chagas disease further complicates access to benznidazole and other essential medicines, as well as access to serodiagnosis and medical counseling. For some individuals with T. cruzi living in the US, immigration status presents an additional challenge to seeking care and prevention services. Just as stigma due to sexual orientation has been a barrier to HIV care and prevention, especially in the beginning of the epidemic, immigration status may function as a deterrent to Chagas disease care and prevention.
Based on the assertions outlined above—the chronic morbidities and high mortalities, the prolonged and expensive treatment courses, the lack of therapeutic options, and barriers to access to essential medicines—a patient living with Chagas disease faces formidable challenges that resemble those faced by someone living with HIV/Aids, especially the challenges that occurred in the early years of the HIV/Aids epidemic.