Faculty of Medicine, Chinese University of Hong Kong, Kowloon, Hong Kong Special Administrative Region.
J Infect Dis. 2012 Nov;206(9):1359-66. doi: 10.1093/infdis/jis509. Epub 2012 Aug 20.
Oseltamivir is widely used as treatment for influenza virus A subtype H5N1 (hereafter, "H5N1") infection but, like any intervention, is not always effective.
We used Avian Influenza Registry data from 10 countries to examine the risk of death in 215 patients with confirmed H5N1 infection who were treated with oseltamivir, according to viral clade, age, respiratory failure, and adjunctive treatment with corticosteroids or antibiotics.
The median age of infected individuals was 18 years, and 50% were male. The highest fatality rate occurred in a country with clade 2.1 virus circulation, and the lowest occurred in countries with clade 2.2 virus circulation (P < .001). In univariate analyses, age of ≤5 years and treatment ≤2 days after symptom onset were protective against fatality. When accounting for all risk factors, early initiation of oseltamivir was found to be particularly effective in individuals without respiratory failure (odds ratio, 0.17; P = .04). Patients who had advanced respiratory failure requiring ventilatory support at the time of oseltamivir initiation were more likely to die from the episode of H5N1 infection than patients who did not (P < .001). Adjunctive therapy did not improve the likelihood of surviving the episode.
Oseltamivir is especially effective for treating H5N1 infection when given early and before onset of respiratory failure. The effect of viral clade on fatality and treatment response deserves further investigation.
奥司他韦被广泛用于治疗甲型 H5N1 流感病毒（以下简称“H5N1”）感染，但与任何干预措施一样，它并不总是有效。
我们使用来自 10 个国家的禽流感登记数据，根据病毒分支、年龄、呼吸衰竭以及皮质类固醇或抗生素辅助治疗，检查 215 例确诊 H5N1 感染患者使用奥司他韦治疗的死亡风险。
感染者的中位年龄为 18 岁，50%为男性。死亡率最高的国家存在 2.1 分支的病毒循环，死亡率最低的国家存在 2.2 分支的病毒循环（P <.001）。在单因素分析中，年龄≤5 岁和症状出现后≤2 天接受治疗与病死率降低有关。在考虑所有危险因素后，发现奥司他韦的早期应用在无呼吸衰竭的个体中尤其有效（比值比，0.17；P =.04）。在奥司他韦开始治疗时需要呼吸支持的严重呼吸衰竭患者比没有呼吸衰竭的患者更有可能死于 H5N1 感染（P <.001）。辅助治疗并不能提高生存的可能性。
奥司他韦在早期且在呼吸衰竭发生之前使用时，对治疗 H5N1 感染特别有效。病毒分支对病死率和治疗反应的影响值得进一步研究。
