Sensitivity of H5N1 Influenza Viruses to Oseltamivir: An Update

Abstract

Continued worldwide circulation of highly pathogenic influenza A (H5N1) viruses has raised concerns that they might adapt to humans and cause a pandemic. Preparedness plans rely on influenza vaccines and on the prophylactic and therapeutic use of neuraminidase inhibitors, especially the orally available drug oseltamivir. Although the efficacy of oseltamivir is well established for uncomplicated seasonal influenza, questions remain about its clinical effectiveness for human H5N1 infections. In this review, available data on the sensitivity of H5N1 viruses to oseltamivir in vitro, in animal models and in human patients are discussed. The factors that might limit the efficacy of oseltamivir treatment for human H5N1 infections are also discussed, in addition to options for improving treatment efficacy and limiting the development of drug resistance.

Keywords::

• antiviral resistance
• antiviral therapy
• H5N1
• influenza
• neuraminidase inhibitors
• oseltamivir
• pandemic preparedness

Acknowledgements

We are very grateful to RJ Russell and JJ Skehel for providing Figure 1.

Financial & competing interests disclosure

This work was supported in part by the viRgil (European Vigilance Network for the Management of Antiviral Drug Resistance, no. LSHM-CT-2004–503359) program. Marie-Anne Rameix-Welti was supported by a fellowship from the Comité des Maladies Infectieuses et Tropicales (Institut Pasteur). The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

We thank Andru Tomoiu for critical reading of the manuscript. No other writing assistance was utilized in the production of this manuscript.

Additional information

Funding

This work was supported in part by the viRgil (European Vigilance Network for the Management of Antiviral Drug Resistance, no. LSHM-CT-2004–503359) program. Marie-Anne Rameix-Welti was supported by a fellowship from the Comité des Maladies Infectieuses et Tropicales (Institut Pasteur). The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed. We thank Andru Tomoiu for critical reading of the manuscript. No other writing assistance was utilized in the production of this manuscript.