Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
Malar J. 2010 Apr 21;9:105. doi: 10.1186/1475-2875-9-105.
Afghanistan's national guidelines recommend chloroquine for the treatment of Plasmodium vivax infection, the parasite responsible for the majority of its malaria burden. Chloroquine resistance in P. vivax is emerging in Asia. Therapeutic responses across Afghanistan have not been evaluated in detail.
Between July 2007 and February 2009, an open-label, randomized controlled trial of chloroquine and dihydroartemisinin-piperaquine in patients aged three months and over with slide-confirmed P. vivax mono-infections was conducted. Consistent with current national guidelines, primaquine was not administered. Subjects were followed up daily during the acute phase of illness (days 0-3) and weekly until day 56. The primary endpoint was the overall cumulative parasitological failure rate at day 56 after the start of treatment, with the hypothesis being that dihydroartemisinin-piperaquine was non-inferior compared to chloroquine (Delta = 5% difference in proportion of failures).
Of 2,182 individuals with positive blood films for P. vivax, 536 were enrolled in the trial. The day 28 cure rate was 100% in both treatment groups. Parasite clearance was more rapid with dihydroartemisinin-piperaquine than chloroquine. At day 56, there were more recurrent infections in the chloroquine arm (8.9%, 95% CI 6.0-13.1%) than the dihydroartemisinin-piperaquine arm (2.8%, 95% CI 1.4-5.8%), a difference in cumulative recurrence rate of 6.1% (2-sided 90%CI +2.6 to +9.7%). The log-rank test comparing the survival curves confirmed the superiority of dihydroartemisinin-piperaquine over chloroquine (p = 0.003). Multivariate analysis showed that a lower initial haemoglobin concentration was also independently associated with recurrence. Both regimens were well tolerated and no serious adverse events were reported.
Chloroquine remains an efficacious treatment for the treatment of vivax malaria in Afghanistan. In a setting where radical therapy cannot be administered, dihydroartemisinin-piperaquine provides additional benefit in terms of post-treatment prophylaxis, reducing the incidence of recurrence from 4-8 weeks after treatment.
阿富汗国家指南建议使用氯喹治疗间日疟原虫感染，这种寄生虫是其大部分疟疾负担的罪魁祸首。氯喹在间日疟原虫中的耐药性正在亚洲出现。阿富汗各地的治疗反应尚未详细评估。
2007 年 7 月至 2009 年 2 月，进行了一项针对三个月及以上经幻灯片确认的间日疟原虫单感染患者的氯喹和双氢青蒿素-哌喹的开放性、随机对照试验。根据现行国家指南，未给予伯氨喹。在疾病的急性阶段（第 0-3 天）每天对患者进行随访，直至第 56 天。主要终点是治疗开始后第 56 天的总体累积寄生虫学失败率，假设双氢青蒿素-哌喹与氯喹相比非劣效（失败比例差异为 5%）。
在 2182 名疟原虫阳性的个体中，536 名入组了试验。两组在第 28 天的治愈率均为 100%。双氢青蒿素-哌喹比氯喹更快地清除寄生虫。在第 56 天，氯喹组的复发性感染（8.9%，95%CI 6.0-13.1%）多于双氢青蒿素-哌喹组（2.8%，95%CI 1.4-5.8%），累积复发率差异为 6.1%（双侧 90%CI+2.6 至+9.7%）。比较生存曲线的对数秩检验证实了双氢青蒿素-哌喹优于氯喹（p = 0.003）。多变量分析表明，初始血红蛋白浓度较低也与复发独立相关。两种方案均耐受良好，无严重不良事件报告。
氯喹仍是阿富汗间日疟的有效治疗方法。在不能给予根治性治疗的情况下，双氢青蒿素-哌喹在治疗后预防方面提供了额外的益处，可将治疗后 4-8 周的复发发生率降低。
