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BENEFIT Trial Chagas — SCE Infectious Diseases MCQ

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HardTropical & Imported InfectionsBENEFIT Trial ChagasSCE Infectious Diseases

A 40-year-old man from Central America presents with chronic cardiac failure. Echo shows dilated cardiomyopathy with apical aneurysm. T. cruzi serology is positive on two assays. He has NYHA class III heart failure. What is the role of Benznidazole in chronic Chagas cardiomyopathy?

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Correct answer: A — The BENEFIT trial showed Benznidazole achieved parasitological clearance but did NOT significantly reduce cardiac clinical outcomes in chronic Chagas cardiomyopathy — anti-trypanosomal treatment may still be offered but the primary focus should be heart failure management and ICD assessment

The BENEFIT trial (2015, NEJM) was the definitive RCT for Benznidazole in chronic Chagas cardiomyopathy. Result: Benznidazole significantly reduced T. cruzi detection (parasitological benefit) but did NOT reduce the composite cardiac endpoint (death, sustained VT, insertion of CIED, new heart failure, stroke) over 5 years. Despite this, some guidelines still recommend offering Benznidazole (potential long-term benefit, parasitological clearance) while acknowledging the cardiac outcome data. Heart failure management follows standard guidelines. ICD for arrhythmia risk.

Reference: WHO 2024 – Chagas; BENEFIT Trial 2015 – NEJM