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Project

The impact of artesunateamodiaquine retreatment and specific malaria humoral immunity on recrudescent malaria infections. (QUINACT)

The Ministry of Health of the Democratic Republic of Congo recommends artesunate-amodiaquine (ASAQ), an artemisinin-based combination therapy, as first line treatment for uncomplicated malaria. Treatment failure for ASAQ is below 10% and the recommend rescue treatment is quinine. However, because of its poor tolerability and prolonged treatment course, the effectiveness of quinine monotherapy is lower than that of any other ACT.
In real-life conditions, patients are often retreated with the recommended first line drug, i.e. ASAQ. Luckily, PCR analysis shows that 75 % or more of the ASAQ treatment failures are new infections. Furthermore, recrudescences have low, easy-to-eliminate, parasite densities. Therefore, we will compare, in a non-inferiority, randomised, controlled trial, the efficacy of ASAQ versus Quinine as a rescue treatment for uncomplicated P.falciparum malaria in Congolese children under 5 years of age. Considering the key role of humoral immunity in controlling parasite densities and treatment efficacy, we will determine whether antibody to key merozoite antigens and Variant Surface Antigens (VSA) are associated with parasite densities and treatment outcome. VSA have been recently reported as inversely associated with parasite density and risk of treatment failure. A better understanding of malaria immunity and in particular VSA immunity in children might have implications for the deployment of future malaria vaccines.
Date:1 Jan 2011  →  31 Dec 2015