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Abstract
Background The use of Amodiaquine monotherapy is associated with the selection of resistance markers (Pfcrt and Pfmdr1). The decrease in sensitivity and the emergence of Plasmodium falciparum-resistant strains have been reported.
It is therefore important to know the impact of treatment of uncomplicated malaria with amodiaquine−artesunate (AQ−AS) on Pfcrt76T and Pfmdr1 86Y mutations strains of P. falciparum.
Methods We applied the standard protocol of 28 days of WHO 2003, to determine the in vivo efficacy of the combination AQ−AS. In total 170 subjects were included in the study. Molecular analysis focused on 168 dried blood spots. The aims were to determine the frequency of Pfcrt76T and Pfmdr1 86Y mutations, to determine the rates of reinfection using polymorphism markers MSP1, MSP2, and microsatellite CA1, Ta87, TA99. Nested PCR followed in some cases by a restriction enzyme.
Results The level of P. falciparum clinical response was 92.85% (156/168) of ACPR before molecular correction and 7% (12/170) LPF. The ACPR after molecular was 97.01% (163/168). The frequency of mutation point Pfcrt 76T was 76.19% (128/168) before treatment and 100% (7/7) after treatment, p=0.14. For Pfmdr1 mutation the frequency was 27.97% (47/168) before treatment and 60% (6/10) after treatment, p=0.03. Rate of Pfcrt76T +Pmdr1 86Y was 22.02% (37/168) before and 50% (6/12) after treatment p=0.003.
Conclusions Despite the combination of AQ with AS, the treatment selected Pfcrt76T and Pfmdr1 86Y mutations in Guinea.
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