TOPLINE:
COVID-19 antivirals can trigger viral rebound in ambulatory patients, according to an analysis published on November 14, 2023 in Annals of Internal Medicine.
METHODOLOGY:
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An observational cohort study compared patients with acute COVID-19 who received 5 days of nirmatrelvir-ritonavir (N-R [Paxlovid]; n = 72) to similar patients who did not receive the treatment (n = 55). All patients were seen in ambulatory settings.
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Researchers compared rates of reinfection, which was defined as an initial positive test followed by a negative result and then another positive result within 20 days.
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Rates of increased viral shedding were compared between the two groups as another measure of viral rebound.
TAKEAWAY:
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One in 5 people (15 in 72, 20%) who took N-R had viral rebound compared with just 1 in 55 people who did not.
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Those who took N-R were older, more likely to be immunocompromised, and had received a greater number of COVID-19 vaccinations (four on average) than did people who did not receive it (three on average).
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Eight of the 16 people with viral rebound also reported symptom rebound, and two were completely asymptomatic.
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People who had received N-R and eventually experienced a rebound showed viral shedding for a median of 14 days compared with a median of 3 days among people who did not rebound who were also taking the drug.
IN PRACTICE:
“For patients with COVID-19 with a low-risk for severe disease, the possibility of prolonged shedding should be factored into the consideration of potential risks and benefits of treatment,” the researchers write.
SOURCE:
Mark Siedner, MD, MPH, an infectious disease researcher at Massachusetts General Hospital in Boston is the study’s corresponding author. The primary funder is the National Institutes of Health.
LIMITATIONS:
The study is observational and retrospective and relied on viral shedding as a proxy for contagiousness rather than directly measuring disease transmission.
DISCLOSURES:
Additional funders included the Massachusetts Consortium on Pathogen Readiness SARS CoV-2 Variants Program, and the Massachusetts General Hospital Department of Medicine. Various authors reported speaking or consulting relationships with pharmaceutical companies.
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