Abstract: medRxiv preprint doi: https://doi.org/10.1101/2020.08.05.20151027; this version posted August 11, 2020. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. It is made available under a CC-BY-ND 4.0 International license . Time to negative PCR from symptom onset in COVID-19 patients on Hydroxychloroquine and Azithromycin - A real-world experience Sarfraz Saleemi1, Abdulrahman Alrajhi2, Mohammed Alhajji1, Areej Alfattani3, Faisal Albaiz1 1 Section of Pulmonary Medicine, Department of Medicine King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia 2 Section of Infectious Diseases, Department of Medicine King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia 3 Department of Biostatistics, Epidemiology and Scientific Computing. King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia Corresponding author: 1 Sarfraz Saleemi Section of Pulmonary Medicine, Department of Medicine MBC 46, King Faisal Specialist Hospital & Research Center, Riyadh 11211, PO Box 3354, Saudi Arabia Email: ssaleemi@kfshrc.edu.sa ABSTRACT: Background: The role of hydroxychloroquine (HCQ) and azithromycin in the treatment of COVID-19 and its effect on SARS-CoV-2 viral clearance is not known. Methods: This is a retrospective observational study to assess the effect of HCQ and Azithromycin on duration from symptom onset to negative SARS-CoV-2 PCR using nasopharyngeal swab in hospitalized patient with COVID-19. Eighty-five patients were included in the study, 65 in HCQ (Hydroxychloroquine + Azithromycin) and 20 in non-HCQ group. Measurement of duration from symptom onset to negative PCR and effect of gender, age and disease severity on time to viral clearance was measured. NOTE: This preprint reports new research that has not been certified by peer review and should not be used to guide clinical practice. medRxiv preprint doi: https://doi.org/10.1101/2020.08.05.20151027; this version posted August 11, 2020. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. It is made available under a CC-BY-ND 4.0 International license . Results: Median time to negative PCR in HCQ group was 23 days (IQR: 9, Mean 24+8, N=65) compared with non-HCQ group, 19 days (IQR: 8, Mean 18+6, N=20), (p <0.05). Forty-one (63%) patients in HCQ group and all patients (100%) in non-HCQ group had mild disease. Multivariate regression model (F=6.8, P<0.002, R2=0.20) shows that being in HCQ group would delay the time to negative PCR by 7 days (95%CI: 2-12) and with every year increase in the age, the time to negative PCR would be delayed by 0.12 days (95%CI: 0.017-0.22). Among HCQ sub-groups, gender and disease severity had no effect on duration (p 0.142 and 0.156 respectively) but older patients >60 year had longer duration compared to patients <60 year of age although p value did not reach significance (p 0.073). Median time to negative PCR in mildHCQ group (23 days, IQR: 9, Mean 23+8, N=41) was longer when compared with non-HCQ group (p <0.05). On day 28, all patients in non-HCQ group had negative PCR while only 50/65 (77%) were negative in HCQ group. Conclusion: Hydroxychloroquine (HCQ) and azithromycin delay SARS-CoV-2 virus clearance in hospitalized patients with COVID-19 and it is correlated with..