COVID: Relapse of symptoms after baxovirus, a possible but rare phenomenon, according to the Mayo Clinic

Mayo Clinic researchers report that a rebound of Covid symptoms can be observed after baxolphoid, but it remains very rare. If the symptoms are most often mild, then the phenomenon is intriguing, and at the moment remains without a clear explanation.

This work, published in Clinical Infectious Diseases, is based on a retrospective group follow-up of 483 high-risk patients treated with the oral combination of nirmatrelvir/ritonavir. Relapse was defined as recurrence of Covid symptoms after five full days of oral antiviral administration and assessed after 30 days. While it is not recommended that you test yourself within 90 days of being infected with Sars-CoV-2, no Covid tests are available to determine the replication of the virus.

Only four participants (0.8%) experienced any symptoms again after treatment, for an average of nine days afterward. “Everything was resolved without additional treatment directed against Covid-19”The authors say. In the end, the treatment proved to be beneficial for everyone.

In the group, patients, with a mean age of 63 years, were mostly vaccinated and many received a booster dose. Although they were in great danger, none of them were immunocompromised. Only two patients have been hospitalized and the reason is not Covid-19.

Regarding the four patients involved, the team led by Dr. Aditya Shah detailed their clinical history: a 75-year-old coronary patient with stronger cough and myalgia after 19 days of treatment; 40-year-old woman, severely obese, with hypertension and renal failure, asthenia and sore throat after 6 days; A 69-year-old man with hypertension, obesity, rhinitis and cough after 10 days; and a 70-year-old man with severe obesity, hypertension, dyslipidemia with a history of prostate cancer and sinus congestion 10 days later.

Clinical status of the infectious disease researcher

This study appears a few days after the clinical case study of the American researcher specializing in AIDS, David Hu, in “JAMA”. Ironically, the director of the Aaron Diamond AIDS Research Center at Columbia University contracted Sars-CoV-2 during a trip to Paris last April for a conference on Covid.

Oddly enough, the PCR test was negative with the treatment before it turned positive again. The highly accurate scientist, who took the oral antiviral within 12 hours of the first symptoms, determines that at D4 the PCR test was negative and the symptoms had disappeared. He lifted his isolation, but continued to test himself daily. After six antigen tests and a negative PCR test, he woke up one morning in disrepair and was promptly retested: the antigen test was positive, a result confirmed by polymerase chain reaction (PCR).

Few other cases have been reported and the US Centers for Disease Control and Prevention (CDC) has issued a warning stressing that symptoms are often mild.

Many assumptions, no certainty

How do we explain this phenomenon? Is it due to disease or medication? The question is not settled. But in their advisory, the CDC wrote that ” A short return of symptoms may be part of the natural history of Sars-CoV-2 in some people, regardless of treatment with Paxlovid and regardless of vaccination status”. Moreover, analysis of Epic-HR, the main Paxlovid trial, showed that approximately 1 to 2% of patients in both groups (placebo and Paxlovid) tested positive after they were negative, indicating a treatment-related absence. It is also possible for the Omicron variant to show a later peak and/or take longer to shed the original strain. Other hypotheses are mentioned: Is the introduction too early? Is the treatment time sufficient? But without any certainty.

For the Mayo Clinic researchers, future studies are needed to answer these questions, noting that the four patients involved in their study had comorbidities that complicate recovery. For Dr. Carlos del Río, an infectious disease specialist at Emory College of Medicine, while doctors are often afraid of drug interactions in candidate patients, “The biggest challenge we’re having with this drug right now is that it’s not being prescribed as often as it should be.”He writes in a clinical case discussion on David Hu.

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