Kinetics of glucose-6-phosphate dehydrogenase (G6PD) activity during Plasmodium vivax infection in French Guiana

Abstract

Abstract Background: Plasmodium vivax is responsible for relapses through hepatic hypnozoites. To avoid these issues, we use primaquine, which is contraindicated in cases of glucose-6-phosphate-dehydrogenase (G6PD) deficiency. In French Guiana, G6PD activity is measured on day-14 of antimalarial treatment, to avoid misclassifying deficient patients in this hemolytic context. The aim of this study was to evaluate the kinetics of G6PD during a malaria attack to assess its variations over time. Methods: This was a retrospective monocentric study. We collected G6PD activity between day-1 and day-28 in patients treated with chloroquine or artemisinin-based combination therapy (ACT) at Cayenne Hospital between January 2018 and December 2020. Patients were divided into 3 arms based on the number of available assessments of G6PD. The global group included arms 1, 2 and 3. Findings: G6PD activity varied significantly over time (p = 0.004) and stabilized from day 3 onwards. None of the G6PD-deficient patients had false normal assays in the acute phase of the malaria attack. Conversely, we observed that patients with G6PD activity below 80% at D3 normalized at D14. Sex and reticulocyte count were statistically associated with G6PD variation. Thirty patients (26.5%) were lost to follow-up before primaquine treatment. Among the 223 patients included in the global group, none had severe G6PD deficiency and only 3 (1.35% ± 0.78) had a deficiency between 10 and 30%. Interpretation: G6PD activity varies over time during P. vivax attack. The G6PD value of the third day is reliable and could be used as a reference for primaquine administration. This could decrease early recurrences and reduce loss to follow-up before primaquine treatment. This proposition requires confirmation in larger prospective studies.