There are additional parallels. Chagas disease has emerged as an important blood transfusion–related risk throughout the Americas just as HIV/AIDS did in the early 1980s, prior to the implementation of widespread blood screening and testing [18]–[20]. Moreover, mother-to-child transmission leading to congenital Chagas disease and other adverse neonatal outcomes is increasingly recognized [21]–[24] (Table 2). Both congenital Chagas disease and HIV/AIDS have a recognized clinical syndrome [21], [25], with adverse birth outcomes as well as deleterious maternal effects in pregnancy [22], [23], [26]. During pregnancy, the rate of vertical transmission of T. cruzi infection is approximately 5% (although some investigators believe the rate could be as high as 10%), whereas it is 15%–40% for untreated HIV/AIDS [27] and 1%–2% for mothers who receive antiretroviral therapy [28]. The Pan American Health Organization estimates that there are over 14,000 cases of congenital Chagas disease in Latin America [29], with 2,000 newborns infected annually in North America alone [24], compared to 36,000 pediatric HIV/AIDS cases in Latin America [15].

It is only appropriate to point out that there are important differences between Chagas disease and HIV/AIDS. Whereas HIV/AIDS is almost always a fatal condition in the absence of antiviral therapy, up to 70%–80% of people with Chagas disease do not progress to cardiomyopathy. Moreover, Chagas disease is a true NTD and there is a paucity of anti-protozoan drugs available for this condition, whereas HIV/AIDS can no longer be considered neglected in this sense as there is an armamentarium of antiretroviral drugs currently available (although for both conditions, patients in developing countries suffer from lack of access to essential medicines). As another contrast between the two diseases, there is also evidence for oral transmission of Chagas through food contamination in the Amazon basin [30].

Over the last three decades of the global HIV/AIDS pandemic, an aggressive and committed activist community has achieved success in promoting widespread access to antiretroviral drugs in developed and developing countries. As a result, at present millions of people living with HIV/AIDS receive antiretroviral therapy, and pediatric HIV/AIDS has been nearly eliminated as a public health problem in the US [31]. Patient advocacy and global efforts to promote access to benznidazole and other therapies for Chagas disease, on the other hand, are at a much earlier stage. In the last decade, MSF has launched efforts to screen more than 80,000 people in Bolivia, Colombia, Guatemala, Honduras, Nicaragua, and Paraguay, having diagnosed and treated more than 6,000 and 4,000 individuals, respectively [12]. Other non-governmental organizations have also been engaged in Chagas disease treatments. Of great concern is a looming shortage of benznidazole, as well as the over-reliance on a single drug manufacturer, and inadequate international efforts to organize global production and distribution of the drug in Latin America [12]. Nifurtimox, another drug commonly used in the treatment of Chagas disease, should also be made available for the LAC region.

In parallel with global advocacy efforts, expansion of operational research activities is crucial to optimize the efficacy of existing control and elimination efforts, including the testing of more field-adapted tools [12]. There are also requirements to expand vector control activities and health education in the communities affected by Chagas disease, in addition to providing training for local health care providers in endemic areas [12]. The importance of a research and development agenda to develop new and improved Chagas disease drugs cannot be overlooked. As noted above, both antitrypanosomal drugs used for the treatment of Chagas disease, benznidazole and nifurtimox, require prolonged and expensive treatment courses; moreover, the efficacy of either drug for the treatment of late chronic infection and Chagasic cardiomyopathy still remains uncertain and unproven [32], [33]. Toxicities and the frequency of side effects of both medicines frequently require patients to interrupt or halt treatments, and both drugs are contraindicated in pregnancy [34]–[36]. In response to this crisis, the product development partnership (PDP) Drugs for Neglected Diseases initiative (DNDi) is accelerating the development of new Chagas disease drugs in the non-profit sector, in parallel with a small group of academic laboratories that are pursuing several drug targets [37], [38]. Finally, just as the International AIDS Vaccine Initiative (IAVI) PDP is developing several experimental HIV/AIDS vaccines, the Sabin Vaccine Institute PDP is accelerating the development of a new therapeutic Chagas disease vaccine in collaboration with several key universities and public sector biotechnology and manufacturing institutions in Mexico [1]. In further support of this research, a recent analysis by Lee and his colleagues confirms the potential cost effectiveness of Chagas disease vaccines [39].

Stark similarities exist between today's global Chagas disease epidemic and the first two decades of the HIV/AIDS epidemic. This translates into a humanitarian catastrophe for the poorest people in the Americas and elsewhere. This perceptible health disparity demands urgent attention by global health policy makers to prioritize Chagas disease and develop a comprehensive strategy for control and elimination efforts, blood screening and point-of-care testing, maternal and child interventions, health education, and parallel research and development. Successfully addressing the vast burden of Chagas disease will require overcoming the current lack of available drugs, together with expanding vector control strategies and developing new and innovative control tools. To this end, eliminating Chagas disease will require a commitment from international health agencies, governments of the disease-endemic countries, PDPs, and patient advocacy groups.