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In the Democratic Republic of the Congo (DRC), artesunate-amodiaquine is first-line therapy for falciparum malaria; little is known about the prevalence of molecular markers of parasite drug resistance. Across the DRC, we genotyped 166 parasites in Plasmodium falciparum chloroquine resistance transporter (pfcrt) using polymerase chain reaction (PCR) and sequencing. Of these parasites, 73 (44%) parasites were pure wild-type CVMNK, 55 (31%) parasites were chloroquine-resistant CVIET, 35 (21.1%) parasites were mixed CVMNK and CVIET, and 3 parasites were other genotypes. Ninety-two infections (55.4%) harbored the pfcrt K76T substitution that is highly correlated with chloroquine failure. The amodiaquine-resistant SVMNT haplotype was absent. Geographically, pfcrt haplotypes were not clearly clustered. Chloroquine accounted for 19.4% of antimalarial use, and amodiaquine accounted for 15.3% of antimalarial use; there were no associations between drug use and mutant haplotype prevalence. In the DRC, our molecular survey indicates that resistance to chloroquine is substantial but that resistance to amodiaquine is absent. These contrasting findings highlight the need for molecular surveillance of drug resistance to inform malaria control policies.
Financial support: This work was supported by a Summer Undergraduate Research Fellowship from the Office for Undergraduate Research at the University of North Carolina at Chapel Hill (to A.L.A.), a Gillings Innovation Laboratory Award from the University of North Carolina Gillings School of Global Public Health (to S.R.M.), and National Institute of Allergy and Infectious Diseases Award 1R56AI097909 (to S.R.M.).
Authors' addresses: Alejandro L. Antonia, Mark Janko, Michael Emch, and Steven R. Meshnick, University of North Carolina, Chapel Hill, NC, E-mails: firstname.lastname@example.org, email@example.com, firstname.lastname@example.org, and email@example.com. Steve M. Taylor, Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, NC, E-mail: firstname.lastname@example.org. Antoinette K. Tshefu, Ecole de Sante Publique, Faculte de Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo, E-mail: email@example.com.