Dihydroartemisinin piperaquine (DHA PPQ)
Dihydroartemisinin-piperaquine (DHA-PPQ) is an artemisinin-based combination therapy (ACT) used to treat malaria patients. Several mutations in pfkelch13 gene have been reported as a marker for artemisinin-derivative resistance (see Artemisinin), while amplification of pfplasmepsin 2 and pfplasmepsin 3 genes have been associated with piperaquine resistance (see Piperaquine).
Recently, the parasites with a particular combination between pfplasmepsin 2 gene amplification and pfKelch13 mutation C580Y have emerged and spread rapidly across the Greater Mekong subregion. DHA-PPQ treatment failure has been associated with these parasites (Imwong, et al, 2017, Lancet Infect Dis; Amato R, et al, 2018, Lancet Infect Dis).
- The following rules are derived from predicted phenotypes of Artemisinin and Piperaquine.
- Field utilized: pred_ART-R, pred_PPQ-R
| Change | Coding | Interpretation | Phenotype |
|---|---|---|---|
| Absence of resistance marker(s) for Artemisinin and/or Piperaquine | any(pred_ART-R == "Sensitive", pred_PPQ-R == "Sensitive") | Sensitive to at least one drug | Sensitive |
| Presence of resistance markers for both Artemisinin and Piperaquine | all(pred_ART-R == "Resistance", pred_PPQ-R == "Resistance") | Resistant to both drugs | Resistance |
| Otherwise | Otherwise | Undetermined | Undetermined |
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Imwong M, Suwannasin K, Kunasol C, Sutawong K, Mayxay M, Rekol H, et al. The spread of artemisinin-resistant Plasmodium falciparum in the Greater Mekong subregion: a molecular epidemiology observational study. Lancet Infect Dis. 2017;17(5):491-7.
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Amato R, Pearson RD, Almagro-Garcia J, Amaratunga C, Lim P, Suon S, et al. Origins of the current outbreak of multidrug-resistant malaria in southeast Asia: a retrospective genetic study. Lancet Infect Dis. 2018;18(3):337-45.