SARS-CoV 2 Viral Clearance in 1276 Patients: Associated Factors and the Role of Treatment with Hydroxychloroquine and Azithromycin
P Brouqui, D Raoult
Acta Scientific Microbiology, doi:10.31080/asmi.2024.07.1413
Background: The role of hydroxychloroquine (HCQ) in lowering the viral load of patients with COVID-19 is controversial.
Methods: In a retrospective observational study of data collected during care, we aimed to compare viral clearance as determined by qPCR in patients who were treated with hydroxychloroquine (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).
Results: Of the 1 276 patients selected within the hospital database, 776 were treated with HCQ and 500 were not. In the crude analysis, the time from treatment onset to viral clearance was significantly lower in the HCQ group than in the untreated group (logrank test p<.001). When adjusted for age, initial viral load and time from symptom onset to treatment onset, the adjusted hazard ratio of viral clearance for the HCQ group remained statistically significant (hazard ratio 95% CI 1.18 [1.01-1.38], p = .037). We then performed a meta-analysis of 9 similar studies, including this one, collecting a total of 1461 HCQ-treated patients and 958 controls. It showed a shortened SARS-CoV-2 viral clearance in the HCQ group on day 7 and 14, OR 1.54 (95% CI [1.26;1.89]), OR 2.47 (95% CI [0.55;11.17] respectively.
Conclusion: although age, initial viral load, and time to treatment do influence the viral load in patients with COVID-19, hydroxychloroquine (HCQ) associated with azithromycin (AZ) still independently significantly lowered viral load more rapidly than other treatments, including azithromycin alone. As the reduction of viral load is associated with the outcome, these data strongly suggest that this treatment would be beneficial in patient with COVID-19.
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