Abed Yacine, Boivin Guy
Research Center in Infectious Diseases of the CHUQ-CHUL and Laval University, Québec City, Québec, Canada.
Open Forum Infect Dis. 2017 May 18;4(3):ofx105. doi: 10.1093/ofid/ofx105. eCollection 2017 Summer.
Anti-influenza drugs play major roles in the management of severe influenza infections. Neuraminidase inhibitors (NAIs), which are active against all influenza A subtypes and the 2 major influenza B lineages, constitute the only class of antivirals recommended for the control of influenza epidemics and eventual pandemics. Thus, the emergence of NAI resistance could be a major clinical concern. Although most currently circulating influenza A and B strains are susceptible to NAIs, clinical cases of influenza viruses harboring single or multiple NA substitutions or deletions conferring a cross-resistance phenotype to the 2 main NAIs (oseltamivir and zanamivir) have been reported, mostly in immunocompromised individuals. Moreover, such events seem to be more frequent in A(H1N1)pdm09 viruses containing the H274Y substitution together with other NA changes (I222R, E119D/G). This review summarizes the therapeutic regimens leading to the emergence of NAI cross-resistant influenza A and B viruses as well as the virologic properties of such variants.
抗流感药物在严重流感感染的治疗中发挥着重要作用。神经氨酸酶抑制剂（NAIs）对所有甲型流感亚型和两种主要的乙型流感谱系均有活性，是唯一一类被推荐用于控制流感流行及最终大流行的抗病毒药物。因此，NAI耐药性的出现可能成为一个主要的临床问题。尽管目前大多数正在传播的甲型和乙型流感毒株对NAIs敏感，但已报告了携带单个或多个NA取代或缺失、对两种主要NAIs（奥司他韦和扎那米韦）具有交叉耐药表型的流感病毒临床病例，大多发生在免疫功能低下的个体中。此外，在含有H274Y取代以及其他NA变化（I222R、E119D/G）的A(H1N1)pdm09病毒中，此类事件似乎更为频繁。本综述总结了导致出现对NAIs产生交叉耐药的甲型和乙型流感病毒的治疗方案以及此类变异株的病毒学特性。
