Abstract
Chloroquine (CQ) use in Mozambique was stopped in 2002 and artemether-lumefantrine (AL) was implemented in 2008. In light of no use of CQ and extensive use of AL, we determined the frequency of molecular markers of Plasmodium falciparum drug resistance/tolerance to CQ and AL in persons living in Linga-Linga, an isolated peninsula and in Furvela village, which is located 8 km inland. The P. falciparum chloroquine resistance transporter gene CVMNK wild type increased in frequency from 43.9% in 2009 to 66.4% in 2010 (P ≤ 0.001), and combined P. falciparum multidrug resistance gene 1 N86-184F-D1246 haplotype increased significantly between years (P = 0.039). The combination of P. falciparum chloroquine resistance transporter gene CVMNK and P. falciparum multidrug resistance gene NFD increased from 24.3% (2009) to 45.3% in (2010, P = 0.017). The rapid changes observed may largely be caused by decreased use of CQ and large-scale use of AL. In the absence of a clear AL-resistance marker and the (almost) continent-wide use of AL in sub-Saharan Africa, and when considering CQ reintroduction, continued monitoring of these markers is needed.
MeSH terms
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Antimalarials / pharmacology
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Artemether, Lumefantrine Drug Combination
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Artemisinins / administration & dosage
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Artemisinins / therapeutic use*
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Chloroquine / pharmacology
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Chloroquine / therapeutic use*
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DNA, Protozoan / genetics
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Drug Combinations
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Drug Resistance / genetics*
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Ethanolamines / administration & dosage
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Ethanolamines / therapeutic use*
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Fluorenes / administration & dosage
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Fluorenes / therapeutic use*
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Haplotypes
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Humans
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Malaria, Falciparum / epidemiology
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Malaria, Falciparum / parasitology
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Membrane Transport Proteins
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Mozambique / epidemiology
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Multidrug Resistance-Associated Proteins / genetics
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Multidrug Resistance-Associated Proteins / metabolism*
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Plasmodium falciparum / drug effects*
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Plasmodium falciparum / genetics
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Plasmodium falciparum / metabolism
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Polymorphism, Single Nucleotide
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Protozoan Proteins
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Selection, Genetic*
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Time Factors
Substances
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Antimalarials
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Artemether, Lumefantrine Drug Combination
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Artemisinins
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DNA, Protozoan
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Drug Combinations
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Ethanolamines
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Fluorenes
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Mdr1 protein, Plasmodium falciparum
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Membrane Transport Proteins
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Multidrug Resistance-Associated Proteins
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PfCRT protein, Plasmodium falciparum
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Protozoan Proteins
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Chloroquine