SARS-CoV-2 Persistent Viral Shedding in the Context of Hydroxychloroquine-Azithromycin Treatment
Michel Drancourt, Sébastien Cortaredona, Cléa Melenotte, Sophie Amrane, Carole Eldin, Bernard La Scola, Philippe Parola, Matthieu Million, Jean-Christophe Lagier, Didier Raoult, Philippe Colson
Viruses, doi:10.3390/v13050890
SARS-CoV-2 nasopharyngeal shedding contributes to the spread of the COVID-19 epidemic. Among 3271 COVID-19 patients treated at the
This was not our situation, where only one patient had lymphoma and another had immunosuppression following kidney transplantation. In addition, several cases of viral shedding beyond 90 days occurred in patients who received treatments with convalescent plasma and/or remdesivir [17, 18] . These situations were not encountered in this series, as no patient received remdesivir or convalescent plasma and the figures reported here were observed in the context of standardized care, including the prescription of hydroxychloroquine and azithromycin treatment. It is noteworthy that almost one quarter of the 34 persistent shedders reported here did not receive the combination of hydroxychloroquine and azithromycin, a prevalence significantly higher than that in short shedders. This standardized care notably differed in other series reporting a higher proportion of persistent shedders, yet populations may not have been similar, bringing into question the impact of combination of hydroxychloroquine plus azithromycin at the dosage prescribed in reducing the time of SARS-CoV-2 nasopharyngeal shedding. This reported series mirrors the first COVID-19 epidemic in our region, which was caused by SARS-CoV-2 of clades 20A, 20B and 20C. Accordingly, based on next-generation population sequencing we did not observe any genotype pattern in any of the 21 patients whose viral genome could be explored. Further ultradeep sequencing of paired early and late nasopharyngeal swabs in the 34 patients..
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'abstract': '<jats:p>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.</jats:p>',
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