SARS-CoV-2 Persistent Viral Shedding in the Context of Hydroxychloroquine-Azithromycin Treatment
Drancourt et al.,
SARS-CoV-2 Persistent Viral Shedding in the Context of Hydroxychloroquine-Azithromycin Treatment,
Viruses, doi:10.3390/v13050890
Retrospective 3,737 patients in France, showing lower risk of persistent viral shedding with HCQ+AZ treatment.
Drancourt et al., 12 May 2021, peer-reviewed, 11 authors, this trial uses multiple treatments in the treatment arm (combined with AZ) - results of individual treatments may vary.
Abstract: viruses
Article
SARS-CoV-2 Persistent Viral Shedding in the Context of
Hydroxychloroquine-Azithromycin Treatment
Michel Drancourt 1,2, *, Sébastien Cortaredona 2,3 , Cléa Melenotte 1 , Sophie Amrane 1,2 , Carole Eldin 2 ,
Bernard La Scola 1,2 , Philippe Parola 2,3 , Matthieu Million 1,2 , Jean-Christophe Lagier 1,2 , Didier Raoult 1,2
and Philippe Colson 1,2
1
2
3
*
Citation: Drancourt, M.;
Cortaredona, S.; Melenotte, C.;
Amrane, S.; Eldin, C.; La Scola, B.;
Parola, P.; Million, M.; Lagier, J.-C.;
Raoult, D.; et al. SARS-CoV-2
Persistent Viral Shedding in the
Context of
Hydroxychloroquine-Azithromycin
Treatment. Viruses 2021, 13, 890.
https://doi.org/10.3390/v13050890
Academic Editor: Oliver Schildgen
Received: 11 March 2021
Accepted: 8 May 2021
Aix Marseille University, IRD, AP-HM, MEPHI, 13005 Marseille, France; clea-leila.melenotte@ap-hm.fr (C.M.);
sophie.amrane@ap-hm.fr (S.A.); bernard.la-scola@univ-amu.fr (B.L.S.); matthieu.million@univ-amu.fr (M.M.);
jean-christophe.lagier@univ-amu.fr (J.-C.L.); didier.raoult@gmail.com (D.R.);
philippe.colson@univ-amu.fr (P.C.)
IHU Méditerranée Infection, 13005 Marseille, France; sebastien.cortaredona@univ-amu.fr (S.C.);
carole.eldin@ap-hm.fr (C.E.); philippe.parola@univ-amu.fr (P.P.)
Aix Marseille University, IRD, SSA, VITROME, 13005 Marseille, France
Correspondence: michel.drancourt@univ-amu.fr; Tel.: +33-413-732-401
Abstract: SARS-CoV-2 nasopharyngeal shedding contributes to the spread of the COVID-19 epidemic.
Among 3271 COVID-19 patients treated at the Hospital University Institute Méditerranée Infection,
Marseille, France from 3 March to 27 April 2020, tested at least twice by qRT-PCR, the median
SARS-CoV-2 nasopharyngeal shedding duration was 6 days (range 2–54 days). Compared with
short shedders (qRT-PCR positivity < 10 days), 34 (1.04%) persistent shedders (qRT-PCR positivity
≥ 17 days; mean ± SD: 23.3 ± 3.8 days) were significantly older, with associated comorbidities,
exhibiting lymphopenia, eosinopenia, increased D-dimer and increased troponin (p < 0.05), and
were hospitalized in intensive care unit in 17.7% vs. 1.1% of cases (p < 0.0001). Viral culture was
positive in six persistent shedders after day 10, including in one patient after day 17, and no viral
co-pathogen was detected in 33 tested patients. Persistent shedders received azithromycin plus
hydroxychloroquine ≥ 3 days in 26/34 (76.5%) patients, a figure significantly lower than in short
shedders (86.6%) (p = 0.042). Accordingly, mortality was 14.7% vs. 0.5% (p < 0.0001). Persistent
shedding was significantly associated with persistent dyspnea and anosmia/ageusia (p < 0.05). In the
context of COVID-19 treatment, including treatment with azithromycin plus hydroxychloroquine, the
persistence of SARS-CoV-2 nasopharyngeal shedding was a rare event, most frequently encountered
in elderly patients with comorbidities and lacking azithromycin plus hydroxychloroquine treatment.
Keywords: SARS-CoV-2; COVID-19; viral persistence; culture; qRT-PCR; hydroxychloroquine;
azithromycin
Published: 12 May 2021
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