Over the past 30 years, the rapid worldwide spread of HIV, in combination with the changing epidemiology of T. cruzi has led to the emergence of T.cruzi/HIV co-infections.

Diagnosis of T. cruzi infection in HIV positive individuals is particularly difficult. When Chagas disease reactivates, especially in a HIV patient, it behaves like a separate disease with acute features such as severe neurological symptoms.

This can lead to misdiagnosis with other infections, the most common differential diagnosis observed being toxoplasmosis. Furthermore, traditional serological diagnostic tests for Chagas are found to be weaker and less sensitive, as HIV-positive patients are less likely to build a strong antibody response against the infection.

The spread of HIV pandemic has not only modified the pathological spectrum of Chagas but also its epidemiology. From the 1980s, when the first case of HIV/T. cruzi co-infection was described to today, cases have been reported in 9 countries (click here to access the world map and list of references for the coinfection cases).

For a long time, Chagas disease remained a disease of the rural world, at the opposite end of the HIV epidemic, initially prevalent in the urban scene.

The rural exodus towards more suburban areas has modified the Chagas disease transmission channels towards non vectorial routes, such as blood transfusion, congenital transmission and organ transplants.

Against this background, T. cruzi came into contact with the HIV pandemic, a typically urban infection in the 1980s. Similarly, HIV spreads from cities to smaller sub-urban, more rural areas, contributing to the increase number of T.cruzi –HIV cases in cities and pseudo-urban areas. In addition, those peri-urban areas are characterized by a very particular population, often poorer, undereducated and with restricted access to proper healthcare. All of which are factors contributing to the risk of co-infection, its spread and the fact that both Chagas disease and HIV-T.cruzi co-infection remain crudely under-diagnosed.

Guidelines with HIV specific clinical features should be improved/promoted and in order to overcome the diagnostical and treatment limitations, it is advisable that HIV + patients be tested for Chagas disease and vice-versa.

More importantly, the severity of clinical features in combination with the high mortality rate, justifies taking action with the goal of achieving earlier detection, antiparasitic treatment and in some case even prophylaxis in cases of coinfection.

It is vital that healthcare professionals share their knowledge since atypical reactivation, such as cerebral reactivation, in patient with HIV is often diagnosed or is mistaken for another disease, notably toxoplasmosis.

The main goal of the following map is to provide a snapshot of cases of coinfection around the globe in order to encourage greater awareness, diagnosis, prevention and monitoring.

This map also pinpoints gaps in information and epidemiology, highlighting places where both infections are known to coexist and demonstrating the need to intensify detection and screening.

Given limited data currently available, the map was created using officially reported and referenced number of coinfected persons globally (see table). Importantly, this map must be considered as an interactive tool and the aim is to update it on an ongoing basis.

Increasing worldwide population movements in recent decades will probably lead to a rise in the number of coinfection in countries where both diseases are present. Epidemiological surveillance is extremely important to predict future trends and direct control efforts.