Carol Yu Centre for Infection and Division of Infectious Diseases, Department of Microbiology, The University of Hong Kong, 4/F University Pathology Bldg, 102 Pokfulam Rd, Queen Mary Hospital, Hong Kong.
Chest. 2010 Apr;137(4):759-68. doi: 10.1378/chest.09-3072. Epub 2010 Jan 8.
The natural history of viral shedding from the upper respiratory tract of the new pandemic 2009 influenza A(H1N1) and the effect of oseltamivir treatment were uncertain.
A retrospective cohort study involving 145 consecutive patients with specimens positive by reverse transcriptase-polymerase chain reaction for the matrix and new H1 genes was conducted.
The nontreated and oseltamivir-treated patients were comparable in their viral load at presentation, demography, and the presenting symptoms. No correlation was observed between viral load with age and number of symptoms. Viral load of nasopharyngeal aspirate (NPA) was significantly lower in treated than in nontreated patients at day 5 after symptom onset. When oseltamivir was initiated </= 2 days after symptom onset, a greater rate of viral load reduction in NPA of treated patients than that of nontreated patients was observed (-0.638 [95% CI, -0.809 to -0.466] vs -0.409 [95% CI, -0.663 to -0.185] log(10) copies/mL/d post-symptom onset), and the viral load was undetectable at day 6 after oseltamivir initiation, which was 1 day earlier than that of those whose treatment was initiated > 2 days of symptom onset. The viral load was inversely correlated with concomitant absolute lymphocyte count in nontreated patients (Pearson correlation coefficient [r] = -0.687, P = .001) and treated patients (Pearson r = -0.365, P < .001). Resolution of fever was 1.4 days later in nontreated than treated patients (P = .012)
The natural viral load profile was described. Oral oseltamivir suppresses viral load more effectively when given early in mild cases of pandemic 2009 influenza A(H1N1) infections.
新型大流行性 2009 年甲型 H1N1 流感病毒从呼吸道上部排出的自然史以及奥司他韦治疗的效果尚不确定。
对 145 例连续的逆转录 - 聚合酶链反应（RT-PCR）检测基质和新 H1 基因阳性的患者进行了回顾性队列研究。
未经治疗和奥司他韦治疗的患者在就诊时的病毒载量、人口统计学特征和首发症状上无差异。未观察到病毒载量与年龄和症状数量之间存在相关性。与未经治疗的患者相比，在症状出现后第 5 天，接受奥司他韦治疗的患者鼻咽抽吸物（NPA）中的病毒载量明显更低。当奥司他韦在症状出现后 </= 2 天开始使用时，与未经治疗的患者相比，接受奥司他韦治疗的患者的 NPA 病毒载量下降更快（-0.638 [95%置信区间（CI），-0.809 至 -0.466]与 -0.409 [95% CI，-0.663 至 -0.185] log10 拷贝/mL/d 症状出现后），并且在奥司他韦开始治疗后第 6 天病毒载量即可检测不到，比症状出现后 2 天开始治疗的患者提前 1 天。在未经治疗的患者中，病毒载量与同时期的绝对淋巴细胞计数呈负相关（Pearson 相关系数 [r] = -0.687，P =.001）和治疗患者（Pearson r = -0.365，P <.001）。未治疗患者的退热时间比治疗患者晚 1.4 天（P =.012）。
描述了自然病毒载量特征。在轻度大流行性 2009 年甲型 H1N1 流感感染病例中，早期给予奥司他韦治疗可更有效地抑制病毒载量。
