Purpose of review <p>The purpose of this review is to provide a comprehensive overview of Chagas disease as an opportunistic infection in AIDS, elucidate critical gaps in the literature, and outline priorities for future clinical research.</p> Recent findings <p>New promising tools for diagnosis include <i>T. cruzi</i> loop-mediated isothermal amplification, a non-invasive Chunap urine antigen test, and rRNA sequencing. People living with AIDS may benefit from sequential quantitative PCR testing for early detection of reactivation. This method is also a promising tool for treatment response monitoring. Prompt antitrypanosomal treatment and antiretrovirals are crucial for reducing morbidity and mortality. Several novel compounds and repurposed agents have shown preliminary activity against <i>T. cruzi</i>. Secondary prophylaxis may not be necessary, as relapse rarely occurs in patients on antiretrovirals.</p> Summary <p>Although primarily endemic to South America, increasing global migration has increased the prevalence of HIV/<i>T. cruzi</i> coinfection in non-endemic regions. Early recognition, timely treatment, and prevention strategies are crucial to reducing associated morbidity and mortality.</p>