Perspective:

While most cardiologists in the United States have not had much exposure to patients with Chagas’ cardiomyopathy, the condition places a large burden on the population of Central and South America. Migration patterns on the continent may eventually change that. It is estimated that 300,000 infected immigrants reside in the United States. There are more than 5 million people with the chronic parasitic infection of Trypanosoma cruzi in the Americas, of whom up to 25% have or will eventually develop cardiomyopathy. There has been a growing movement toward broader treatment of chronically infected adults, including those with early cardiomyopathy, in the hope that such treatment will reduce progression of the disease. Unfortunately, the large randomized clinical trial BENEFIT has shown that treatment with benznidazole for 80 days did not affect clinical outcomes over a period of 5 years, although it was effective in reducing serum parasite detection. It may have been too late in the evolution of the disease for the antiparasitic treatment to provide benefit or perhaps this well designed and conducted study did not last long enough to show such a benefit.