Skip to main content
Download PDF
- Main
Symptom and Viral Rebound in Untreated SARS-CoV-2 Infection
- Deo, Rinki;
- Choudhary, Manish C;
- Moser, Carlee;
- Ritz, Justin;
- Daar, Eric S;
- Wohl, David A;
- Greninger, Alexander L;
- Eron, Joseph J;
- Currier, Judith S;
- Hughes, Michael D;
- Smith, Davey M;
- Chew, Kara W;
- Li, Jonathan Z;
- Javan, Arzhang Cyrus;
- Giganti, Mark;
- Hosey, Lara;
- Roa, Jhoanna;
- Patel, Nilam;
- Colsh, Kelly;
- Rwakazina, Irene;
- Beck, Justine;
- Sieg, Scott;
- Fletcher, Courtney;
- Fischer, William;
- Evering, Teresa;
- Ignacio, Rachel Bender;
- Cardoso, Sandra;
- Corado, Katya;
- Jagannathan, Prasanna;
- Jilg, Nikolaus;
- Perelson, Alan;
- Pillay, Sandy;
- Riviere, Cynthia;
- Singh, Upinder;
- Taiwo, Babafemi;
- Gottesman, Joan;
- Newell, Matthew;
- Pedersen, Susan;
- Dragavon, Joan;
- Jennings, Cheryl;
- Greenfelder, Brian;
- Murtaugh, William;
- Kosmyna, Jan;
- Gapara, Morgan;
- Shahkolahi, Akbar
Published Web Location
https://doi.org/10.7326/m22-2381Abstract
Background
Although symptom and viral rebound have been reported after nirmatrelvir-ritonavir treatment, the trajectories of symptoms and viral load during the natural course of COVID-19 have not been well described.Objective
To characterize symptom and viral rebound in untreated outpatients with mild to moderate COVID-19.Design
Retrospective analysis of participants in a randomized, placebo-controlled trial. (ClinicalTrials.gov: NCT04518410).Setting
Multicenter trial.Patients
563 participants receiving placebo in the ACTIV-2/A5401 (Adaptive Platform Treatment Trial for Outpatients With COVID-19) platform trial.Measurements
Participants recorded the severity of 13 symptoms daily between days 0 and 28. Nasal swabs were collected for SARS-CoV-2 RNA testing on days 0 to 14, 21, and 28. Symptom rebound was defined as a 4-point increase in total symptom score after improvement any time after study entry. Viral rebound was defined as an increase of at least 0.5 log10 RNA copies/mL from the immediately preceding time point to a viral load of 3.0 log10 copies/mL or higher. High-level viral rebound was defined as an increase of at least 0.5 log10 RNA copies/mL to a viral load of 5.0 log10 copies/mL or higher.Results
Symptom rebound was identified in 26% of participants at a median of 11 days after initial symptom onset. Viral rebound was detected in 31% and high-level viral rebound in 13% of participants. Most symptom and viral rebound events were transient, because 89% of symptom rebound and 95% of viral rebound events occurred at only a single time point before improving. The combination of symptom and high-level viral rebound was observed in 3% of participants.Limitation
A largely unvaccinated population infected with pre-Omicron variants was evaluated.Conclusion
Symptom or viral relapse in the absence of antiviral treatment is common, but the combination of symptom and viral rebound is rare.Primary funding source
National Institute of Allergy and Infectious Diseases.Many UC-authored scholarly publications are freely available on this site because of the UC's open access policies. Let us know how this access is important for you.
Main Content
For improved accessibility of PDF content, download the file to your device.
Enter the password to open this PDF file:
File name:
-
File size:
-
Title:
-
Author:
-
Subject:
-
Keywords:
-
Creation Date:
-
Modification Date:
-
Creator:
-
PDF Producer:
-
PDF Version:
-
Page Count:
-
Page Size:
-
Fast Web View:
-
Preparing document for printing…
0%