Disentangling SARS-CoV-2 Sustained Viremia Cases: Evolution, Persistence and Reinfection.

Area of Science:

• Virology
• Infectious Diseases
• Oncology

Background:

• Recurrence of positive SARS-CoV-2 tests post-recovery raises questions about viral reactivation, reinfection, or multiple infections.
• Distinguishing these scenarios requires advanced viral quasispecies analysis.

Purpose of the Study:

• To differentiate between persistent SARS-CoV-2 infection and reinfection in cancer patients using viral quasispecies analysis.
• To investigate the within-host evolution dynamics of SARS-CoV-2 in persistent infections.

Main Methods:

• Longitudinal analysis of 26 cancer patients with extended SARS-CoV-2 follow-up.
• Nucleic acid isolation, PCR amplification, and high-throughput sequencing.
• Phylogenetic reconstruction for viral classification and case definition.

Main Results:

• Identified 9 confirmed and 12 plausible cases of persistent SARS-CoV-2 infection.
• Demonstrated virus evolution dynamics within the intrahost population during persistent infection.
• Confirmed 3 and identified 2 plausible cases of SARS-CoV-2 reinfection, including one multiple infection case.

Conclusions:

• This study provides the first detailed analysis of SARS-CoV-2 within-host variants, reinfections, and evolution in cancer patients.
• Understanding within-host viral population dynamics is crucial for the natural history of COVID-19.