%0 Journal Article
%9 ACL : Articles dans des revues avec comité de lecture répertoriées par l'AERES
%A Mairet-Khedim, M.
%A Nsango, S.
%A Ngou, C.
%A Menard, S.
%A Roesch, C.
%A Khim, N.
%A Srun, S.
%A Iriart, X.
%A Lanot, T.
%A Otam, L.
%A Abega, F.
%A Ayong, L.
%A Morlais, Isabelle
%A Gandia, P.
%A Witkowski, B.
%A Berry, A.
%T Efficacy of dihydroartemisinin/piperaquine in patients with non-complicated Plasmodium falciparum malaria in Yaounde, Cameroon
%D 2021
%L PAR00023799
%G ENG
%J Journal of Antimicrobial Chemotherapy
%@ 0305-7453
%K CAMEROUN ; YAOUNDE
%M ISI:000737577800041
%N 11
%P 3037-3044
%R 10.1093/jac/dkab281
%U https://www.documentation.ird.fr/hor/PAR00023799
%V 76
%W Horizon (IRD)
%X Background: Dihydroartemisinin/piperaquine is increasingly used for the treatment of uncomplicated Plasmodium falciparum malaria in Africa. The efficacy of this combination in Cameroon is poorly documented, while resistance to dihydroartemisinin/piperaquine readily spreads in Southeast Asia. Objectives: This study evaluated the clinical efficacy of dihydroartemisinin/piperaquine in Cameroon, as well as the molecular profile and phenotypic susceptibility of collected isolates to dihydroartemisinin and piperaquine. Patients and methods: Dihydroartemisinin/piperaquine efficacy in 42days was followed-up for 138 patients presenting non-complicated falciparum malaria. Piperaquine concentration was determined at day 7 for 124 patients. kelch13 gene polymorphisms (n=150) and plasmepsin2 gene amplification (n=148) were determined as molecular markers of resistance to dihydroartemisinin and piperaquine, respectively. Parasite susceptibility to dihydroartemisinin and piperaquine was determined using validated in vitro survival assays. Results: The efficacy of dihydroartemisinin/piperaquine treatment was 100% after PCR correction. The reinfections were not associated with a variation of piperaquine concentration at day 7. Ninety-six percent (144/150) of the samples presented a WT allele of the kelch13 gene. Two percent (3/150) presented the non-synonymous mutation A578S, which is not associated with resistance to dihydroartemisinin. No duplication of the plasmepsin2 gene was observed (0/148). All the samples tested in vitro by survival assays (n=87) were susceptible to dihydroartemisinin and piperaquine. Conclusions: Dihydroartemisinin/piperaquine has demonstrated excellent therapeutic efficacy with no evidence of emerging artemisinin or piperaquine resistance in Yaounde, Cameroon. This observation suggests that dihydroartemisinin/piperaquine could be a sustainable therapeutic solution for P. falciparum malaria if implemented in areas previously free of artemisinin- and piperaquine-resistant parasites, unlike Southeast Asia.
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