In a paper recently published in Research Square*, researchers reported an immediate relapse of coronavirus disease 2019 (COVID-19) symptoms after treatment with nirmatrelvir/ritonavir in adults.
Nirmatrelvir inhibits the main protease (Mpro) of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and blocks viral replication. The antiviral drug especially reduces the severity of the disease in other people at risk.
The clinical study observed a relapse of COVID-19 symptoms and viral load after early treatment with nirmatrelvir/ritonavir. A 71-year-old man with intermittent asthma developed a sore throat, rhinorrhea, cough, coryza, chills, fever and fatigue on day 0, with a positive SARS-CoV-2 antigen test. Oral nirmatrelvir/ritonavir was started twice daily from day 0 to day 5.
Symptoms temporarily disappeared with only asthma and mild rhinorrhea on day 1 and completely resolved on day 8. While still isolated, the patient evolved with rhinorrhea, coryza, sore throat and asthma on day 9. On day 12. Antigen tests came back negative on days 16 and 35. Biofire’s respiratory pathogen detection panel tested positive for SARS-CoV-2 and negative for the remaining respiratory viruses on day 10.
Molecular sequencing revealed that the infectious variant SARS-CoV-2 Omicron BA. 1. 20 from day 1 to day 11. A substitution of Pthirteen2H in non-structural protein five (nspfive), discovered in 98% of THE BA. 1. 20 sequences, is provided constantly at all times. Positive for anti-peak serum immunoglobulin G (IgG) on day thirteen and positive for anti-nucleocapsid IgG on day 21.
Another patient (69 years old) developed with bleeding symptoms and tested positive for SARS-CoV-2 at an antigen control on day 0. Treatment with nirmatrelvir/ritonavir began on day 1 for five days; symptoms resolved on day four. Between days four and 9, daily antigen checks and two polymerase chain reaction (PCR) controls were negative. The patient evolved with mild symptoms on day 10 and relapse manifested itself through antigenic controls and PCR. The relapse lasted 3 days.
The third patient was a 50-year-old woman and a relative of the patient at the time. The patient experienced a similar trend of relapse after complete resolution of symptoms after treatment with nirmatrelvir/ritonavir. Sequencing of samples from the moment and the third known patient Omicron BA . 2. 9 as the infectious variant.
In addition, seven (presumed) cases with relapse were known, adding two members of the first patient’s household. All patients were vaccinated and gained a BOOSTer of the COVID-19 mRNA vaccine two weeks to six months prior to SARS-CoV-2 infection. No patients were immunocompromised; the antiviral course was started on days 0 to 2, disappearing symptoms 3 to 8 days after the start of treatment.
Symptoms relapsed five days on average after the end of treatment with nirmatrelvir/ritonavir. Cold symptoms were maximum, not unusual, although some patients experienced fatigue and headaches. In these patients, relapse symptoms were milder than those of the acute/initial infection. any patient. All patients recovered without the need for antiviral treatment.
Antigen tests came back negative on days nine to thirteen and remained positive for an average six days until day 18, beyond the advised isolation period. Relapses have been reported in two cases of SARS-CoV-2 transmission. Two family members of one patient (63 years old) were in close contact when the patient relapsed. Contacts developed symptoms and tested positive for SARS-CoV-2 within 3 days.
While presymptomatic on day 12, one patient (aged 67) had been in close contact with a member of the six-month-old circle of relatives for 15 to 20 minutes. The baby tested positive 3 days later and developed symptoms. Subsequently, the child’s parents were symptomatic after two or three days and tested positive for antigen. In particular, the baby and the parents had no other close contact.
The study observed immediate recurrence of COVID-19 symptoms after early and effective treatment with nirmatrelvir/ritonavir. Sequencing samples from three patients indicated that the relapse was not the result of a mutation that gave the impression of being under treatment or another infectious variant. However, further research is needed to investigate the etiology, duration, spectrum and frequency of recurrent symptoms and their combination with the remedy nirmatrelvir/ritonavir.
Research Square publishes initial clinical reports that are not peer-reviewed and therefore should not be considered as conclusive clinical practices/health-related behaviors or treated as established information.
Written By
Tarun was founded in Hyderabad, India. He holds a master’s degree in Biotechnology from the University of Hyderabad and is passionate about clinical studies. She enjoys reading study articles and literature reviews and is passionate about writing.
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Sai Lomte, Tarun. (2022, August 30). Relapse of COVID-19 symptoms and SARS-CoV-2 viral load after remedy with nirmatrelvir/ritonavir. Actualités-Médical. Retrieved September 13, 2022 from https://www. news-medical. net/news/20220830/Relapse-covid-19-symptoms-and-SARS-CoV-2-viral load-following-nirmatrelvirritonavir-remedyArrayaspx.
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Sai Lomte, Tarun. 2022. Relapse of COVID-19 symptoms and SARS-CoV-2 viral load after treatment with nirmaterlvir/ritonavir. News-Medical, accessed September 13, 2022, https://www. news-medical. net/ news/20220830/Relapse-of-COVID-19-symptoms-and-SARS-CoV-2-viral-load-after-nirmatrelvirritonavir-remedy. aspx.
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