在大群体中大量使用抗疟疾药物和药物耐药性的演变
Tran Dang Nguyen1, Thu Nguyen-Anh Tran1, Daniel M Parker2
1Center for Infectious Disease Dynamics, Department of Biology, Pennsylvania State University, PA, United States of America.
PLOS global public health
|July 26, 2023
概括
针对疟疾的大规模药物管理 (MDA) 可以加快药物耐药性,如果不仔细计划. 确保MDA后高治疗覆盖率对于成功消除疟疾和防止耐药性传播至关重要.
科学领域:
- * 传染病传播动态的数学建模.
- * 在Plasmodium falciparum中抗药性的遗传学和演变.
背景情况:
- *与抗疟疾药物一起的大规模药物管理 (MDA) 可以减少疟疾的流行和传播.
- *MDA可以消除对药物敏感和耐药的寄生虫,延长药物的疗效.
- * 了解导致MDA失败和阻力恶化的条件对于消除策略至关重要.
研究的目的:
- *为了评估由于MDA导致抗疟疾耐药性加速的风险,使用二甲美西宁-皮佩拉昆 (DHA-PPQ).
- * 确定MDA可能会失败并恶化药物耐药性的条件.
- * 评估MDA后治疗覆盖率对疟疾消除的影响.
主要方法:
- * 利用基于个体的Plasmodium falciparum传播的随机模型.
- *模拟MDA与DHA-PPQ在具有可变抗疟疾药物获取和寄生虫再进口的种群中.
- *在不同的遗传瓶和选择压力的不同场景下评估了耐药性演变.
主要成果:
- *在特定条件下,MDA可以加快艺术素耐药性:不完全的寄生虫清除,耐药菌株的重新进口以及MDA后的持续选择压力.
- * 疟疾病例在MDA后复苏后出现加速耐药性,这是由例行病例管理选择驱动的,而不是MDA本身.
- *在MDA后增加治疗覆盖率显著提高了在低传播环境下局部消除的概率.
结论:
- *如果没有满足关键条件,MDA失败可能会加剧抗疟疾耐药性,特别是与二甲美西宁-皮佩拉昆 (DHA-PPQ) 相关.
- * 在例行病例管理过程中,MDA后的选择压力是抵抗演变的关键驱动因素.
- *在MDA之后,持续高覆盖率的诊断和治疗对于实现局部疟疾消除和预防耐药性至关重要.
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