Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK.
Institute of Infection and Immunity, St George's University of London, London, UK.
Malar J. 2022 Jun 11;21(1):186. doi: 10.1186/s12936-022-04181-y.
The World Health Organization (WHO) recommends surveillance of molecular markers of resistance to anti-malarial drugs. This is particularly important in the case of mass drug administration (MDA), which is endorsed by the WHO in some settings to combat malaria. Dihydroartemisinin-piperaquine (DHA-PPQ) is an artemisinin-based combination therapy which has been used in MDA. This review analyses the impact of MDA with DHA-PPQ on the evolution of molecular markers of drug resistance. The review is split into two parts. Section I reviews the current evidence for different molecular markers of resistance to DHA-PPQ. This includes an overview of the prevalence of these molecular markers in Plasmodium falciparum Whole Genome Sequence data from the MalariaGEN Pf3k project. Section II is a systematic literature review of the impact that MDA with DHA-PPQ has had on the evolution of molecular markers of resistance. This systematic review followed PRISMA guidelines. This review found that despite being a recognised surveillance tool by the WHO, the surveillance of molecular markers of resistance following MDA with DHA-PPQ was not commonly performed. Of the total 96 papers screened for eligibility in this review, only 20 analysed molecular markers of drug resistance. The molecular markers published were also not standardized. Overall, this warrants greater reporting of molecular marker prevalence following MDA implementation. This should include putative pfcrt mutations which have been found to convey resistance to DHA-PPQ in vitro.
世界卫生组织（WHO）建议监测抗疟药物耐药性的分子标志物。在大规模药物治疗（MDA）的情况下，这一点尤为重要，WHO 在某些情况下支持MDA 来对抗疟疾。二氢青蒿素-哌喹（DHA-PPQ）是一种青蒿素为基础的联合疗法，已在 MDA 中使用。本综述分析了 MDA 与 DHA-PPQ 对耐药性分子标志物演变的影响。该综述分为两部分。第一部分回顾了 DHA-PPQ 耐药性不同分子标志物的现有证据。这包括对疟疾基因 Pf3k 项目的恶性疟原虫全基因组序列数据中这些分子标志物的流行情况的概述。第二部分是对 MDA 与 DHA-PPQ 对耐药性分子标志物演变的影响的系统文献综述。本系统综述遵循 PRISMA 指南。本综述发现，尽管 MDA 后 DHA-PPQ 的耐药性分子标志物监测被 WHO 认为是一种公认的监测工具，但在 MDA 后进行耐药性分子标志物监测的情况并不常见。在本综述中筛选的 96 篇合格论文中，只有 20 篇分析了药物耐药性的分子标志物。发表的分子标志物也没有标准化。总体而言，这需要在 MDA 实施后更广泛地报告分子标志物的流行情况。这应该包括在体外发现对 DHA-PPQ 有耐药性的假定 pfcrt 突变。
