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BackgroundHemoglobin (Hb) data are limited in Southeast Asian glucose-6-phosphate dehydrogenase (G6PD) deficient (G6PD-) patients treated weekly with the World Health Organization-recommended primaquine regimen (ie, 0.75 mg/kg/week for 8 weeks [PQ 0.75]).MethodsWe treated Cambodians who had acute Plasmodium vivax infection with PQ0.75 and a 3-day course of dihydroartemisinin/piperaquine and determined the Hb level, reticulocyte count, G6PD genotype, and Hb type.ResultsSeventy-five patients (male sex, 63) aged 5-63 years (median, 24 years) were enrolled. Eighteen were G6PD deficient (including 17 with G6PD Viangchan) and 57 were not G6PD deficient; 26 had HbE (of whom 25 were heterozygous), and 6 had α-/β-thalassemia. Mean Hb concentrations at baseline (ie, day 0) were similar between G6PD deficient and G6PD normal patients (12.9 g/dL [range, 9‒16.3 g/dL] and 13.26 g/dL [range, 9.6‒16 g/dL], respectively; P = .46). G6PD deficiency (P = ConclusionsThe first PQ0.75 exposure was associated with the greatest decrease in Hb level and 1 blood transfusion, followed by clinically insignificant decreases in Hb levels. PQ0.75 requires monitoring during the week after treatment. Safer antirelapse regimens are needed in Southeast Asia.Clinical trials registrationACTRN12613000003774.

Original publication

DOI

10.1093/infdis/jiz313

Type

Journal

The Journal of infectious diseases

Publication Date

10/2019

Volume

220

Pages

1750 - 1760

Addresses

National Center for Parasitology, Entomology, and Malaria Control, Phnom Penh, Cambodia.

Keywords

Humans, Malaria, Vivax, Glucosephosphate Dehydrogenase Deficiency, Hemolysis, Primaquine, Glucosephosphate Dehydrogenase, Hemoglobins, Antimalarials, Reticulocyte Count, Chemoprevention, Adolescent, Adult, Middle Aged, Child, Child, Preschool, Asian Continental Ancestry Group, Female, Male, Secondary Prevention, Young Adult