Rebound of COVID-19 Symptoms after Nirmatrelvir/Ritonavir Treatment for COVID-19 in High-Risk Patients
Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America: Published on June 2022
COVID rebound has been reported to occur 2 to 8 days after initial recovery and is characterized by a recurrence of COVID-19 symptoms or a positive viral test after having tested negative. The CDC recommends that health care providers continue monitoring patients with recurring symptoms and advise them to take precautions to prevent further transmission.
Recent case reports show some patients with normal immune response who have completed a five-day course of Nirmatrelvir/Ritonavir for laboratory-confirmed infection have experienced recurrent illness two to eight days after initial recovery.
A brief return of symptoms may be part of the natural history of SARS-CoV-2 infection in some people, independent of treatment with Nirmatrelvir/Ritonavir and regardless of vaccination status, according to the CDC.
TAKE-HOME MESSAGE
This single-center retrospective study cataloged the characteristics of rebound symptoms following the completion of treatment with nirmatrelvir–ritonavir for mild to moderate outpatient COVID-19.
Authors conducted a retrospective review among patients who received NM/R treatment for mild-to-moderate severe acute respiratory syndrome coronavirus 2. Data were included for 483 patients (median age, 63 years) who had a high risk for severe disease progression. Overall, 93 percent of the patients were fully vaccinated.
483 patients showed improvements at the time of the treatment.
The researchers found that four of the patients (0.8 percent) experienced symptom rebound, defined as recurrence of COVID-19 symptoms following successful completion of five days of NM/R therapy, at a median of 9 days after NM/R treatment. All four were fully vaccinated.
Only 0.8 percent of 483 patients with mild-to-moderate SARS-CoV-2 at high risk for severe disease progression had rebound.
None of the patients required hospitalization or other COVID-19 therapeutics, and no alternative diagnoses were found. All improved without further treatment.
Information available from case reports suggests that patients treated with Nirmatrelvir/Ritonavir who experience COVID-19 rebound have had mild illness; there are no reports of severe disease.
There also is no evidence that additional treatment is needed with Nirmatrelvir/Ritonavir or other therapies for SARS-CoV-2 when COVID-19 rebound is suspected.
Doctors Liked to Read More
Researchers think one explanation could be that a replication of the SARS-CoV-2 virus — the virus that causes COVID-19 — may have triggered a secondary immune response that showed up as mild COVID-19 symptoms.
They also note that all four patients with rebound symptoms had many serious health problems known as comorbidities — a factor known to complicate recoveries. Also, all four patients had been vaccinated more than 90 days before becoming infected with COVID-19.
The authors offer several possible explanations with respect to the rebound symptoms, including inadequately controlled infection related to the insufficient duration of therapy or a biphasic pattern of viral replication occurring independent of therapeutics.
Among the patients who developed rebound of symptoms after NM/R treatment, the clinical presentation was mild and did not require COVID-19 directed therapies.
The CDC issued the health advisory amid reports that some patients who tested positive for COVID-19 and were treated with Nirmatrelvir/Ritonavir had a recurrence of COVID-19 symptoms.
There is no evidence that additional treatment for COVID-19 is needed for patients experiencing “COVID-19 rebound” after taking the antiviral Nirmatrelvir/Ritonavir, according to a health advisory from the Centers for Disease Control and Prevention (CDC).
In the advisory, the CDC recommends health care providers advise patients with COVID-19 rebound to follow its guidance on isolation. Patients should re-isolate for at least five days. They can end their re-isolation period after five full days if fever has resolved for 24 hours (without the use of fever-reducing medicine) and symptoms are improving. The patient should wear a mask for 10 days after rebound symptoms started.
Health care providers also should consider clinical evaluations of patients who have COVID-19 rebound and symptoms that persist or worsen.
Comments
You must login to write comment