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Comparative Study
. 2009 Sep 7:8:211.
doi: 10.1186/1475-2875-8-211.

PfHRP2 and PfLDH antigen detection for monitoring the efficacy of artemisinin-based combination therapy (ACT) in the treatment of uncomplicated falciparum malaria

Sandrine Houzé  1 , Mainoumata Dicko Boly, Jacques Le Bras, Philippe Deloron, Jean-François Faucher
Affiliations
Comparative Study

PfHRP2 and PfLDH antigen detection for monitoring the efficacy of artemisinin-based combination therapy (ACT) in the treatment of uncomplicated falciparum malaria

Sandrine Houzé et al. Malar J. .

Abstract

Background: An assessment of the accuracy of two malaria rapid diagnostic tests (RDT) for the detection of Plasmodium falciparum histidine-rich protein 2 (PfHRP2) or Pf lactate dehydrogenase (PfLDH) was undertaken in children aged between six and 59 months included in an anti-malarial efficacy study in Benin.

Methods: In Allada (Benin), 205 children aged 6-59 months with falciparum malaria received either artesunate-amodiaquine (ASAQ), artemether-lumefantrine (AL), or sulphadoxine-pyrimethamine (SP). Children included in the study were simultaneously followed by both RDT and high-quality microscopy for up to 42 days.

Results: At the time of inclusion, PfHRP2-based tests were positive in 203 children (99%) and PfLDH-based tests were positive in 204 (99.5%). During follow-up, independent of the treatment received, only 17.3% (28/162) of children effectively cured were negative with the PfHRP2 RDT at day 3, with a gradual increase in specificity until day 42. The specificity of antigen detection with the PfLDH test was 87% (141/162) on day 3, and between 92% and 100% on days 7 to 42. A statistical difference was observed between the persistence of PfHRP2 and PfLDH antigenaemia during follow-up in children treated with artemisinin-based combination therapy (ACT) but not with SP.

Conclusion: Although both RDTs are as sensitive as microscopy in detecting true malaria cases, the PfHRP2 RDT had very low specificity during follow-up until day 28. On the other hand, the PfLDH test could be used to detect failures and, therefore, to assess anti-malarial efficacy.

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Figures

Figure 1
Figure 1
Proportion of children with false-positive PfHRP2-based test or PfLDH-based test during follow-up, stratified by day-0 parasite density. PfHRP2: parasite density: black triangle: 50,000 - 525,000 p/μL; black square: 10,000 - 50,000 p/μl; black diamond: 1,000 - 10,000 p/μl. PfLDH: parasite density: white triangle: 50,000 - 525,000 p/μL; white square: 10,000 - 50,000 p/μl; white diamond: 1,000 - 10,000 p/μl.
Figure 2
Figure 2
Proportion of true-negative and false-positive results for PfHPR2 and PfLDH according to the treatment during follow-up. (SP: sulphadoxine-pyrimethamine; ASAQ: artesunate-amodiaquine, AL: artemether-lumefantrine). Statistical analysis of antigen detection specificities for ACT compared to SP and for PfLDH compared to PfHPR2 are shown on the right: ***: p0.001; **: p < 0.01: *: p < 0.05, ns: not significant.
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