Table 5.
Selection of pfcrt and pfmdr1 genotypes after treatment with artemether-lumefantrine and artesunate-amodiaquine*
| Marker | Genotype | Recurrence | Recrudescence | Re-infection | |||
|---|---|---|---|---|---|---|---|
| AL | ASAQ | AL | ASAQ | AL | ASAQ | ||
| pfcrt 76 | K → T† | 16% (89/571) | 10% (25/237) | 5% (4/73) | 20% (7/35) | 17% (82/493) | 9% (17/196) |
| T → K | 30% (171/571) | 8% (18/237) | 25% (18/73) | 11% (4/35) | 31% (152/493) | 7% (14/196) | |
| No change | 54% (311/571) | 82% (194/237) | 70% (51/73) | 69% (24/35) | 53% (259/493) | 84% (165/196) | |
| P value | < 0.001 | 0.286 | 0.004 (exact) | 0.366 | < 0.001 | 0.590 | |
| pfmdr1 86 | N → Y | 13% (95/712) | 27% (92/341) | 10% (10/101) | 18% (5/28) | 14% (85/609) | 28% (87/308) |
| Y → N | 40% (286/712) | 16% (54/341) | 31% (31/101) | 14% (4/28) | 42% (255/609) | 16% (49/308) | |
| No change | 46% (331/712) | 57% (195/341) | 59% (60/101) | 68% (19/28) | 44% (269/609) | 56% (172/308) | |
| P value | < 0.001 | 0.002 | 0.001 | 0.739 | < 0.001 | 0.001 | |
| pfmdr1 184 | Y→ F | 24% (74/311) | 12% (37/303) | 20% (14/69) | 12% (3/25) | 25% (60/242) | 12% (34/273) |
| F → Y | 16% (51/ 311) | 17% (50/303) | 14% (10/69) | 4% (1/25) | 17% (41/242) | 18% (49/273) | |
| No change | 60% (186/311) | 71% (216/303) | 65% (45/69) | 84% (21/25) | 58% (141/242) | 70% (190/273) | |
| P value | 0.040 | 0.163 | 0.414 | 0.625 | 0.059 | 0.100 | |
| pfmdr1 1246 | D → Y | 14% (38/273) | 32% (102/317) | 11% (5/44) | 39% (11/28) | 15% (33/227) | 32% (90/284) |
| Y → D | 32% (86/273) | 19% (60/317) | 30% (13/44) | 14% (4/28) | 32% (73/227) | 20% (56/284) | |
| No change | 54% (149/273) | 49% (155/317) | 59% (26/44) | 46% (13/28) | 53% (121/227) | 48% (138/284) | |
| P value | < 0.001 | 0.001 | 0.059 | 0.119 | < 0.001 | 0.005 | |
| pfmdr1 copy number | 1 → 2 or more | 1% (2/269) | – | 4% (2/53) | – | 0 | – |
| 2 or more → 1 | 1% (3/269) | – | 2% (1/53) | – | 1% (2/216) | – | |
| No change | 98% (264/269) | – | 94% (50/53) | – | 99% (214/216) | – | |
| P value | 1.000 (exact) | 1.000 (exact) | 0.500 (exact) | ||||
Values in bold indicate statistically significant selection (P < 0.05) by using McNemar's paired test. Those marked exact were tested by using the exact distribution for small sample sizes. A small number of recurrent infections (4 for AL and 6 for ASAQ) were not polymerase chain reaction–adjusted and were excluded from the analysis of recrudescent and re-infections. pfcrt = Plasmodium falciparum chloroquine resistance transporter gene; pfmdr1 = P. falciparum multidrug resistance 1 (pfmdr1) gene; AL = artemether-lumefantrine; ASAQ = artesunate –amodiaquine.
Each category includes all changes from one allele to another. For example, K → T includes K→ T, K→ K/T, and K/T → T changes.