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PERSISTENCE OF PLASMODIUM FALCIPARUM HRP2 ANTIGEN AFTER EFFECTIVE ANTIMALARIAL THERAPY.

O S Michael1, A E Orimadegun2, C O Falade1

  • 1Department of Pharmacology and Therapeutics, College of Medicine, University of Ibadan, Nigeria.

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Histidine Rich Protein 2 (HRP2) based malaria rapid diagnostic tests (mRDTs) show persistent antigenemia in children for 28 days post-treatment. HRP2-based mRDTs are not recommended for monitoring antimalarial therapy effectiveness.

Keywords:
HRP2MalariaNigeriaPersistenceRDT

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Area of Science:

  • Malariology
  • Diagnostic testing
  • Pediatric infectious diseases

Background:

  • Histidine Rich Protein 2 (HRP2) based malaria rapid diagnostic tests (mRDTs) offer an alternative to microscopy.
  • Persistence of HRP2 antigenemia is a known limitation of HRP2-based mRDTs.

Purpose of the Study:

  • To evaluate the performance of an HRP2-based mRDT in children under five.
  • To assess HRP2 antigen persistence over a 28-day follow-up period after treatment.

Main Methods:

  • Prospective study enrolling 226 children under five with fever.
  • Malaria RDT and expert microscopy performed at enrollment and on days 1, 2, 3, 7, 14, 21, and 28.
  • Comparison of RDT results with expert microscopy, considering faint test lines as positive.

Main Results:

  • High concordance between microscopy and RDT at enrollment (100% vs. 95.6%).
  • Significant HRP2 antigen persistence observed: 94.6% RDT positivity on day 3, decreasing to 80.6% on day 28, despite low microscopy positivity (16.5%).
  • Lower HRP2 persistence noted in children with parasite density below 200/µL, warranting further investigation.

Conclusions:

  • A high proportion of children exhibit persistent HRP2 antigenemia for 28 days after effective antimalarial therapy.
  • HRP2-based mRDTs are unsuitable for monitoring the effectiveness of antimalarial treatments.
  • Further research is needed to understand factors influencing HRP2 antigen persistence.