Histidine-rich protein 2 deletions index

HRP2 gene deletion Gene-deletion mutations affecting HRP2 and HRP3 genes have been reported in South America, sub-Saharan Africa, and Asia, most likely though genetic selection of cases not detected by RDT testing. (1) Deletions of HRP2 prevent its synthesis, causing reduced sensitivity (or sometimes entirely negative test results). In the presence of high parasitaemia HRP2 tests may still work even in the presence of single gene deletions of HRP2 since the test also detects HRP3 protein. (2) Note also the dual gene-deletions affecting both HRP2 and HRP3 genes are now recognised, and these cause fully negative test results. The use of HRP to detect malaria may not be appropriate where the HRP2 deletion rate is 5% or greater. Tests that combine HRP2 with another antibody (either aldolase or pLDH) may help overcome these problems.