持久性SARS-CoV-2病毒泄露≥8周的免疫功能低下患者,临床结果和病毒学动态:回顾性多中心队列研究,2020-2024年
Clémentine de La Porte des Vaux1, Nicolas Veyrenche2, Kevin Da Silva3
1Department of Infectious and Tropical Diseases, Hôpital Necker Enfants Malades, Assistance Publique des Hôpitaux de Paris (APHP), IHU Imagine, Université Paris Cité, Paris, France.
持久性SARS-CoV-2感染的免疫功能低下患者从直接抗病毒药物中受益. 这些治疗促进了更快的病毒清除和临床恢复,没有观察到对关键药物的耐药性突变.
科学领域:
- 传染性疾病 传染性疾病
- 病毒学 病毒学
- 免疫学 免疫学 免疫学
背景情况:
- 免疫功能低下的患者 (ICPs) 面临严重的SARS-CoV-2疾病和长时间的病毒分泌.
- 持续脱落 (>8周) 与死亡率和侵入性真菌感染相关.
- 关于这些ICP的临床概况和管理策略的数据有限.
研究的目的:
- 分析具有持续的SARS-CoV-2脱落症状的ICP的临床形状.
- 评估不同治疗方案对病毒清除和临床结果的影响.
- 评估ICPs中抗病毒耐药性突变的出现情况.
主要方法:
- 对53名有症状的ICP患者进行了回顾性队列研究,SARS-CoV-2脱落时间超过8周.
- 对临床进展,病毒清除时间和耐药性突变的分析.
- 基于治疗方案的结果比较:直接抗病毒药物,单克隆抗体 (mAbs),康复期血.
主要成果:
- 32%经历了严重的感染,91%需要住院治疗,17%患有侵袭性菌感染.
- 与mAbs或康复性血 (P=0.03) 相比,直接抗病毒疗法导致显著更快的病毒清除.
- 没有出现对remdesivir或nirmatrelvir/ritonavir的耐药性突变;然而,54%的菌株表现出对mAbs.的尖端蛋白耐药性.
结论:
- 直接抗病毒药物,包括remdesivir和nirmatrelvir/ritonavir,对于ICPs持续的SARS-CoV-2感染是安全有效的.
- 这些疗法加速病毒清除和临床恢复.
- 单克隆抗体由于新兴的尖端蛋白抵抗性而显示出有限的疗效.
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