Fractal analysis of peripheral blood neutrophil chromatin in patients infected with Trypanosoma cruzi and/or HIV correlates with left ventricle ejection fraction, T CD4+, and T CD8+ lymphocytes levels

Fractal analysis (FA) of neutrophils has demonstrated potential in identifying changes in chromatin associated with clinical parameters in individuals with chronic diseases. Therefore, this study aimed to investigate FA of neutrophils' nuclei from patients with Trypanosoma cruzi and/or HIV. Fifty-three individuals were recruited and divided into four groups: T. cruzi-infected patients with chronic chagasic cardiomyopathy (CCC) (n=18), seropositive HIV individuals (SPHIV) (n=14), T. cruzi-HIV coinfected patients (n=9), and healthy individuals (n=12). Micrographs of neutrophils underwent FA using a box-counting method in the ImageJ software. Clinical parameters obtained from patients' medical records, such as left ventricle mass index (LVMI), left ventricle ejection fraction (LVEF), risk of ischemic stroke (IS), and sudden death were analyzed. FA was lower in patients compared to the control group (P<0.0001). Chagas disease (CD) patients showed higher FA when the LVEF was higher (r=0.53), which increased the risk of sudden death (r=-0.62). In SPHIV, when FA was higher, T CD4+ lymphocyte count was also higher (r=0.66) and the T CD8+ lymphocyte count was lower (r=-0.54). Coinfected individuals showed higher FA, when LVEF (r=0.60), neutrophil to lymphocyte ratio (r=0.80), total lymphocytes (r=0.70), and T CD4+ lymphocyte count (r=0.70) were increased, and T CD8+ lymphocyte count was decreased (r=-0.70). FA was an independent marker of changes in neutrophil chromatin and has proven to be a prognostic tool and a method for risk stratification for adverse events, survival, and mortality in individuals infected with T. cruzi and/or HIV.