Viral clearance in patients with COVID-19: associated factors and the role of antiviral treatment
Philippe Brouqui, Jean-Christophe Lagier, P Parola, M Million, S Cortaredona, Léa Delorme, Philippe Colson, Didier Raoult
doi:10.22541/au.167948825.59270994/v1
The role of hydroxychloroquine (HCQ) in lowering the viral load of patients with COVID-19 is controversial. In our Institute, we treated more than 30,000 people with COVID-19 in 2020 and 2021, using the same diagnostic tools and the same treatment dosages. In this retrospective comparative study of data collected over this period, we aimed to compare the viral clearance in the nasopharynx as determined by qPCR in patients who were treated with HCQ and those who were not. As a new feature, we adjusted the data according to the most significant confounding factors (age, initial viral load, and timescale between the onset of symptoms and treatment). Of the 1 276 patients selected from our database, 776 were treated with HCQ and 500 were not. Viral clearance in the treatment group was reached significantly earlier than in the non-treatment group, at days 5, 10 and 30. These differences remain significant after adjustments for confounding factors. In conclusion, although age, initial viral load, and time to treatment do influence the viral load in patients with COVID-19, hydroxychloroquine associated with azithromycin still independently significantly lowered viral load more rapidly than other treatments, including azithromycin alone.
Hosted file Table 1 .docx available at https://authorea.com/users/410460/articles/631056-viral-clearancein-patients-with-covid-19-associated-factors-and-the-role-of-antiviral-treatment Hosted file Table 2 .docx available at https://authorea.com/users/410460/articles/631056-viral-clearancein-patients-with-covid-19-associated-factors-and-the-role-of-antiviral-treatment Hosted file Table 3 .docx available at https://authorea.com/users/410460/articles/631056-viral-clearancein-patients-with-covid-19-associated-factors-and-the-role-of-antiviral-treatment
References
Ader, Peiffer-Smadja, Poissy, Bouscambert-Duchamp, Belhadi et al., An openlabel randomized, controlled trial of the effect of lopinavir/ritonavir, lopinavir/ritonavir plus IFN-β-1a and hydroxychloroquine in hospitalized patients with COVID-19, Clin Microbiol Infect
Ahmad, Eze, Noulin, Horvathova, Murray et al., EDP-938, a Respiratory Syncytial Virus Inhibitor, in a Human Virus Challenge, N Engl J Med
Asberg, Humar, Rollag, Jardine, Mouas et al., Oral valganciclovir is noninferior to intravenous ganciclovir for the treatment of cytomegalovirus disease in solid organ transplant recipients, Am J Transplant
Biber, Harmelin, Ram, Shaham, Nemet, The effect of ivermectin on the viral load and culture viability in early treatment of nonhospitalized patients with mild COVID-19 -a double-blind, randomized placebo-controlled trial, Int J Infect Dis
Chanouzas, Dyall, Nightingale, Ferro, Moss et al., Valaciclovir to prevent Cytomegalovirus mediated adverse modulation of the immune system in ANCA-associated vasculitis (CAN-VAS): study protocol for a randomised controlled trial, Trials
Fine, Gray, A Proportional Hazards Model for the Subdistribution of a Competing Risk, Journal of the American Statistical Association
Gautret, Hoang, Lagier, Raoult, Effect of hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open-label non-randomized clinical trial, an update with an intention-to-treat analysis and clinical outcomes, International Journal of Antimicrobial Agents
Gautret, Lagier, Parola, Hoang, Meddeb et al., Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open-label non-randomized clinical trial, Int J Antimicrob Agents
Hirai, Nishioka, Sekine, Nishihara, Okuda et al., Factors associated with viral clearance periods from patients with COVID-19: A retrospective observational cohort study, J Infect Chemother
Jaafar, Aherfi, Wurtz, Grimaldier, Hoang et al., Correlation between 3790 qPCR positives samples and positive cell cultures including 1941 SARS-CoV-2 isolates, Clin Infect Dis
Lagier, Million, Gautret, Colson, Cortaredona et al., None, Outcomes
Long, Zhao, Zeng, Lu, Fang et al., Prolonged viral shedding of SARS-CoV-2 and related factors in symptomatic COVID-19 patients: a prospective study, BMC Infect Dis
Owusu, Pomeroy, Lewis, Wadhwa, Yousaf et al., Persistent SARS-CoV-2 RNA Shedding Without Evidence of Infectiousness: A Cohort Study of Individuals With COVID-19, J Infect Dis
Puhach, Meyer, Eckerle, SARS-CoV-2 viral load and shedding kinetics, Nat Rev Microbiol
Recovery Collaborative Group, Horby, Mafham, Linsell, Bell et al., Effect of Hydroxychloroquine in Hospitalized Patients with Covid-19, N Engl J Med
Rojas, Rodríguez, Hernández, Díaz-Coronado, Vergara et al., Safety and efficacy of convalescent plasma for severe COVID-19: a randomized, single blinded, parallel, controlled clinical study, BMC Infect Dis
Schooley, Correlation between viral load measurements and outcome in clinical trials of antiviral drugs, AIDS
Van Wyk, Ajana, Bisshop, Wit, Osiyemi et al., Efficacy and Safety of Switching to Dolutegravir/Lamivudine Fixed-Dose 2-Drug Regimen vs Continuing a Tenofovir Alafenamide-Based 3-or 4-Drug Regimen for Maintenance of Virologic Suppression in Adults Living With Human Immunodeficiency Virus Type 1: Phase 3, Randomized, Noninferiority TANGO Study, Clin Infect Dis
Ventura-López, Cervantes-Luevano, Aguirre-Sánchez, Flores-Caballero, Alvarez-Delgado et al., Treatment with metformin glycinate reduces SARS-CoV-2 viral load: An in vitro model and randomized, double-blind, Phase IIb clinical trial, Biomed Pharmacother
Xu, Chen, Yuan, Yi, Ding et al., Factors Associated With Prolonged Viral RNA Shedding in Patients with Coronavirus Disease 2019 (COVID-19), Clin Infect Dis
Zhang, Chen, Chen, Guo, Zhou et al., The clinical utility of plasma Epstein-Barr virus DNA assays in nasopharyngeal carcinoma: the dawn of a new era?: a systematic review and meta-analysis of 7836 cases, Medicine
