title: Oseltamivir resistance during treatment of influenza A (H5N1) infection.
abstract: Influenza A (H5N1) virus with an amino acid substitution in neuraminidase conferring high-level resistance to oseltamivir was isolated from two of eight Vietnamese patients during oseltamivir treatment. Both patients died of influenza A (H5N1) virus infection, despite early initiation of treatment in one patient. Surviving patients had rapid declines in the viral load to undetectable levels during treatment. These observations suggest that resistance can emerge during the currently recommended regimen of oseltamivir therapy and may be associated with clinical deterioration and that the strategy for the treatment of influenza A (H5N1) virus infection should include additional antiviral agents.
authors.affiliation: Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam. mddejong@hcm.vnn.vn
authors.forename: Menno D
authors.initials: MD
authors.lastname: de Jong
authors.forename: Tan Thanh
authors.initials: TT
authors.lastname: Tran
authors.forename: Huu Khanh
authors.initials: HK
authors.lastname: Truong
authors.forename: Minh Hien
authors.initials: MH
authors.lastname: Vo
authors.forename: Gavin J D
authors.initials: GJ
authors.lastname: Smith
authors.forename: Vinh Chau
authors.initials: VC
authors.lastname: Nguyen
authors.forename: Van Cam
authors.initials: VC
authors.lastname: Bach
authors.forename: Tu Qui
authors.initials: TQ
authors.lastname: Phan
authors.forename: Quang Ha
authors.initials: QH
authors.lastname: Do
authors.forename: Yi
authors.initials: Y
authors.lastname: Guan
authors.forename: J S Malik
authors.initials: JS
authors.lastname: Peiris
authors.forename: Tinh Hien
authors.initials: TH
authors.lastname: Tran
authors.forename: Jeremy
authors.initials: J
authors.lastname: Farrar
mesh_terms: D000081:Acetamides / Q000627:therapeutic use*; D000293:Adolescent; D000328:Adult; D019943:Amino Acid Substitution; D000998:Antiviral Agents / Q000627:therapeutic use*; D001483:Base Sequence; D002648:Child; D024882:Drug Resistance, Viral; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D053124:Influenza A Virus, H5N1 Subtype / Q000235:genetics / Q000302:isolation & purification; D007251:Influenza, Human / Q000188:drug therapy* / Q000821:virology; D008168:Lung / Q000000981:diagnostic imaging; D008297:Male; D009439:Neuraminidase / Q000037:antagonists & inhibitors* / Q000235:genetics; D053139:Oseltamivir; D011024:Pneumonia, Viral / Q000000981:diagnostic imaging / Q000821:virology; D011859:Radiography; D017422:Sequence Analysis, DNA; D019562:Viral Load
chemical_list: D000081:Acetamides; D000998:Antiviral Agents; D053139:Oseltamivir; D009439:Neuraminidase