Hongyan Li1, Menghan Gao2, Hailong You3, Peng Zhang4, Yuchen Pan5, Nan Li6, Ling Qin7, Heyuan Wang8, Dan Li9, Yang Li9, Hongmei Qiao10, Lina Gu6, Songbai Xu11, Weiying Guo8, Nanya Wang12, Chaoying Liu9, Pujun Gao13, Junqi Niu14, Jie Cao15, Yang Zheng7. 1. Nursing Department, The First Hospital of Jilin University, Changchun, China. 2. Department of Hepatobiliary and Pancreatic Surgery, The First Hospital of Jilin University, Changchun, China. 3. Department of Pediatrics, First Hospital of Jilin University, Changchun, China. 4. Department of Infectious Diseases, The First Hospital of Jilin University, Changchun, China. 5. Department of Clinical Epidemiology, The First Hospital of Jilin University, Changchun, China. 6. Intensive Care Unit, The First Hospital of Jilin University, Changchun, China. 7. Department of Cardiovascular Medicine, The First Hospital of Jilin University, Changchun, China. 8. Department of Endocrinology and Metabolism, The First Hospital of Jilin University, Changchun, China. 9. Department of Respiratory Medicine, The First Hospital of Jilin University, Changchun, China. 10. Department of Pediatric Respiratory Medicine, The First Hospital of Jilin University, Changchun, China. 11. Department of Neurosurgery, the First Hospital of Jilin University, Changchun, China. 12. Cancer Center, the First Hospital of Jilin University, Changchun, China. 13. Department of Hepatology, The First Hospital of Jilin University, Changchun, China. 14. Department of Hepatology, Center of Infectious Disease and Pathogen Biology， Key laboratory of Organ Regeneration and Transplantation of the Ministry of Education, State Key Laboratory of Zoonotic Disease, The First Hospital of Jilin University, Changchun, China. 15. Department of Neology, The First Hospital of Jilin University, Changchun, China.
Abstract
BACKGROUND: Acceleration of negative respiratory conversion of SARS-CoV-2 in patients with coronavirus disease 2019 (COVID-19) might reduce viral transmission. Nirmatrelvir/ritonavir is a new antiviral agent recently approved for treatment of COVID-19 that has the potential to facilitate negative conversion. METHODS: A cohort of hospitalized adult patients with mild-to-moderate COVID-19 who had a high-risk for progression to severe disease were studied. These patients presented with COVID-19 symptoms between March 5 and April 5, 2022. The time from positive to negative upper respiratory RT-PCR conversion was assessed by Kaplan-Meier plots and Cox proportional hazards regression with the adjustment for patients baseline demographic and clinical characteristics. RESULTS: There were 258 patients treated with nirmatrelvir/ritonavir and 224 non-treated patients who had mild-to-moderate COVID-19. The median (interquartile range) time for patients who converted from positive to negative RT-PCR was 10 days (7-12 days) in patients treated ≤5 days after symptom onset and 17 days (12-21 days) in non-treated patients, respectively. The proportions of patients with a negative conversion at day 15 were 89.7% and 42.0% in treated patients and non-treated patients, corresponding to a hazard ratio of 4.33 (95% CI, 3.31-5.65). Adjustment for baseline differences between the groups had little effect on the association. Subgroup analysis on treated patients suggests that time to negative conversion did not vary with the patients' baseline characteristics. CONCLUSION: This cohort study of high-risk patients with mild-to-moderate COVID-19 found an association between nirmatrelvir/ritonavir treatment and accelerated negative RT-PCR respiratory SARS-CoV-2 conversion that might reduce the risk of viral shedding and disease transmission.
BACKGROUND: Acceleration of negative respiratory conversion of SARS-CoV-2 in patients with coronavirus disease 2019 (COVID-19) might reduce viral transmission. Nirmatrelvir/ritonavir is a new antiviral agent recently approved for treatment of COVID-19 that has the potential to facilitate negative conversion. METHODS: A cohort of hospitalized adult patients with mild-to-moderate COVID-19 who had a high-risk for progression to severe disease were studied. These patients presented with COVID-19 symptoms between March 5 and April 5, 2022. The time from positive to negative upper respiratory RT-PCR conversion was assessed by Kaplan-Meier plots and Cox proportional hazards regression with the adjustment for patients baseline demographic and clinical characteristics. RESULTS: There were 258 patients treated with nirmatrelvir/ritonavir and 224 non-treated patients who had mild-to-moderate COVID-19. The median (interquartile range) time for patients who converted from positive to negative RT-PCR was 10 days (7-12 days) in patients treated ≤5 days after symptom onset and 17 days (12-21 days) in non-treated patients, respectively. The proportions of patients with a negative conversion at day 15 were 89.7% and 42.0% in treated patients and non-treated patients, corresponding to a hazard ratio of 4.33 (95% CI, 3.31-5.65). Adjustment for baseline differences between the groups had little effect on the association. Subgroup analysis on treated patients suggests that time to negative conversion did not vary with the patients' baseline characteristics. CONCLUSION: This cohort study of high-risk patients with mild-to-moderate COVID-19 found an association between nirmatrelvir/ritonavir treatment and accelerated negative RT-PCR respiratory SARS-CoV-2 conversion that might reduce the risk of viral shedding and disease transmission.
Authors: Eric Y Dai; Kannon A Lee; Audrey B Nathanson; Ariana T Leonelli; Brittany A Petros; Taylor Brock-Fisher; Sabrina T Dobbins; Bronwyn L MacInnis; Amelia Capone; Nancy Littlehale; Julie Boucau; Caitlin Marino; Amy K Barczak; Pardis C Sabeti; Michael Springer; Kathryn E Stephenson Journal: medRxiv Date: 2022-08-04