| Autor: |
Edelstein, Gregory E., Boucau, Julie, Uddin, Rockib, Marino, Caitlin, Liew, May Y., Barry, Mamadou, Choudhary, Manish C., Gilbert, Rebecca F., Reynolds, Zahra, Li, Yijia, Tien, Dessie, Sagar, Shruti, Vyas, Tammy D., Kawano, Yumeko, Sparks, Jeffrey A., Hammond, Sarah P., Wallace, Zachary, Vyas, Jatin M., Barczak, Amy K., Lemieux, Jacob E. |
| Předmět: |
|
| Zdroj: |
Annals of Internal Medicine; Dec2023, Vol. 176 Issue 12, p1577-1585, 10p |
| Abstrakt: |
The association between treatment of acute COVID-19 with nirmatrelvir−ritonavir (N-R) and virologic rebound (VR) is uncertain. This observational cohort study in a multicenter health care system compared the frequency of VR in patients who received 5 days of N-R treatment versus those who received no COVID-19 therapy. Visual Abstract. SARS-CoV-2 Virologic Rebound With Nirmatrelvir–Ritonavir Therapy: The association between treatment of acute COVID-19 with nirmatrelvir−ritonavir (N-R) and virologic rebound (VR) is uncertain. This observational cohort study in a multicenter health care system compared the frequency of VR in patients who received 5 days of N-R treatment versus those who received no COVID-19 therapy. Background: Data are conflicting regarding an association between treatment of acute COVID-19 with nirmatrelvir−ritonavir (N-R) and virologic rebound (VR). Objective: To compare the frequency of VR in patients with and without N-R treatment for acute COVID-19. Design: Observational cohort study. Setting: Multicenter health care system in Boston, Massachusetts. Participants: Ambulatory adults with acute COVID-19 with and without use of N-R. Intervention: Receipt of 5 days of N-R treatment versus no COVID-19 therapy. Measurements: The primary outcome was VR, defined as either a positive SARS-CoV-2 viral culture result after a prior negative result or 2 consecutive viral loads above 4.0 log 10 copies/mL that were also at least 1.0 log 10 copies/mL higher than a prior viral load below 4.0 log 10 copies/mL. Results: Compared with untreated persons (n = 55), those taking N-R (n = 72) were older, received more COVID-19 vaccinations, and more commonly had immunosuppression. Fifteen participants (20.8%) taking N-R had VR versus 1 (1.8%) who was untreated (absolute difference, 19.0 percentage points [95% CI, 9.0 to 29.0 percentage points]; P = 0.001). All persons with VR had a positive viral culture result after a prior negative result. In multivariable models, only N-R use was associated with VR (adjusted odds ratio, 10.02 [CI, 1.13 to 88.74]; P = 0.038). Virologic rebound was more common among those who started therapy within 2 days of symptom onset (26.3%) than among those who started 2 or more days after symptom onset (0%) (P = 0.030). Among participants receiving N-R, those who had VR had prolonged shedding of replication-competent virus compared with those who did not have VR (median, 14 vs. 3 days). Eight of 16 participants (50% [CI, 25% to 75%]) with VR also reported symptom rebound; 2 were completely asymptomatic. No post-VR resistance mutations were detected. Limitations: Observational study design with differences between the treated and untreated groups; positive viral culture result was used as a surrogate marker for risk for ongoing viral transmission. Conclusion: Virologic rebound occurred in approximately 1 in 5 people taking N-R, often without symptom rebound, and was associated with shedding of replication-competent virus. Primary Funding Source: National Institutes of Health. [ABSTRACT FROM AUTHOR] |
| Databáze: |
Complementary Index |
| Externí odkaz: |
|
