One of the major threats to malaria control and elimination efforts is the ongoing spread and emergence of resistance towards commonly used antimalarial drugs to treat P. falciparum and P. vivax infections. Whilst our understanding of drug resistant P. falciparum is quite well understood, the extent and nature of resistance in P. vivax parasites is for the most part is unknown. One of the reasons for this is the difficulty in interpreting P. vivax clinical efficacy studies. Unlike P. falciparum , P. vivax forms hypnozoite liver stages that can lie dormant in the liver for many years before re-emerging. Hence recurrent parasitaemia following treatment can represent recrudescence (the same parasite), reinfection (a new infection) or relapses (an infection arising from the dormant liver stage). Current genotyping methods are unable to distinguish between these patient responses.
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