Factors associated with prolonged viral shedding and impact of lopinavir/ritonavir treatment in hospitalised non-critically ill patients with SARS-CoV-2 infection
Factors associated with prolonged viral shedding and impact of lopinavir/ritonavir treatment in hospitalised non-critically ill patients with SARS-CoV-2 infection
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DOI：
10.1183/13993003.00799-2020
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发表时间：
2020-07-01
影响因子：
24.3
通讯作者：
Gao, Yong-hua
中科院分区：
文献类型：
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作者：
Yan, Dan;Liu, Xiao-Yan;Gao, Yong-hua
背景：病毒排出的持续时间是指导隔离预防措施和抗病毒治疗决策的核心。然而，关于严重急性呼吸系统综合征冠状病毒2型长期脱落相关风险因素的研究（SARS-CoV-2）和洛匹那韦/利托那韦（LPV/r）治疗对病毒脱落的影响仍然很少。数据收集自湖北省第三人民医院隔离病房所有SARS-CoV-2感染患者，中国，2020年1月31日至3月9日。我们比较了接受LPV/r治疗和未接受LPV/r治疗的患者的临床特征和SARS-CoV-2 RNA脱落。结果：120例患者中位年龄为52岁，54例（45%）为男性，78例（65%）接受LPV/r治疗。SARS-CoV-2 RNA检测从症状发作开始的中位持续时间为23天（四分位距18-32天）。年龄较大（OR 1.03，95% CI 1.00-1.05; p=0.03）和缺乏LPV/r治疗（OR 2.42，95% CI 1.10-5.36; p=0.029）是延长SARS-CoV-2 RNA脱落的独立危险因素。在症状发作后10天内开始LPV/r治疗，但从第11天起未开始治疗的患者，与未接受LPV/r治疗的患者相比，病毒排出持续时间显著缩短（中位数19天vs 28.5天;对数秩检验P <0.05）。
Background: The duration of viral shedding is central to the guidance of decisions about isolation precautions and antiviral treatment. However, studies regarding the risk factors associated with prolonged shedding of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the impact of lopinavir/ritonavir (LPV/r) treatment on viral shedding remain scarce.Methods: Data were collected from all SARS-CoV-2 infected patients who were admitted to isolation wards and had reverse transcription PCR conversion at the No. 3 People's Hospital of Hubei province, China, between 31 January and 9 March 2020. We compared clinical characteristics and SARS-CoV-2 RNA shedding between patients initiated with LPV/r treatment and those without. Logistic regression analysis was employed to evaluate the risk factors associated with prolonged viral shedding.Results: Of 120 patients, the median age was 52 years, 54 (45%) were male and 78 (65%) received LPV/r treatment. The median duration of SARS-CoV-2 RNA detection from symptom onset was 23 days (interquartile range 18-32 days). Older age (OR 1.03, 95% CI 1.00-1.05; p=0.03) and the lack of LPV/r treatment (OR 2.42, 95% CI 1.10-5.36; p=0.029) were independent risk factors for prolonged SARS-CoV-2 RNA shedding. Patients who initiated LPV/r treatment within 10 days from symptom onset, but not initiated from day 11 onwards, had significantly shorter viral shedding duration compared with those without LPV/r treatment (median 19 days versus 28.5 days; log-rank p