Department of Biochemistry and Cellular and Molecular Biology, Georgetown University, Washington, District of Columbia.
Department of Chemistry, Georgetown University, Washington, District of Columbia.
Am J Trop Med Hyg. 2019 Dec;101(6):1204-1211. doi: 10.4269/ajtmh.19-0379.
In this review, we provide an epidemiological history of the emergence and ongoing spread of evolving artemisinin resistance (ARTR). Southeast Asia has been the focal point for emergence and spread of multiple antimalarial drug resistance phenomena, and is once again for evolving ARTR, also known as the "delayed clearance phenotype" (DCP). The five countries most impacted, Cambodia, Thailand, Myanmar, Laos, and Vietnam, each have complex histories of antimalarial drug use over many decades, which have in part molded the use of various artemisinin combination therapies (ACTs) within each country. We catalog the use of ACTs, evolving loss of ACT efficacy, and the frequency of mutations (mutations associated with ARTR) in the Greater Mekong Subregion and map the historical spread of ARTR/DCP parasites. These data should assist improved surveillance and deployment of next-generation ACTs.
在这篇综述中，我们提供了青蒿素耐药性（ART）不断出现和持续传播的流行病学历史。东南亚一直是多种抗疟药物耐药现象出现和传播的焦点，也是青蒿素耐药性（也称为“清除延迟表型”（DCP））的再次出现的焦点。受影响最严重的五个国家柬埔寨、泰国、缅甸、老挝和越南，每个国家都有几十年的抗疟药物使用的复杂历史，这些历史在一定程度上塑造了每个国家对各种青蒿素联合疗法（ACT）的使用。我们列出了大湄公河次区域 ACT 的使用情况、ACT 疗效不断丧失的情况以及与 ART 相关的突变（与 ART 相关的突变）的频率，并绘制了 ARTR/DCP 寄生虫的历史传播图。这些数据应有助于改进下一代 ACT 的监测和部署。
