Factors associated with prolonged viral shedding and impact of lopinavir/ritonavir treatment in hospitalised non-critically ill patients with SARS-CoV-2 infection

Abstract

Background The duration of viral shedding is central to guide the decisions of isolation precautions and antiviral treatment. However, studies regarding the risk factors associated with prolonged SARS-CoV-2 shedding and the impact of Lopinavir/Ritonavir (LPV/r) treatment on viral shedding remain scarce. Methods Data were collected from all SARS-CoV-2 infected patients who were admitted to isolation wards and had reverse transcription polymerase chain-reaction conversion at the No.3 People's Hospital of Hubei province between 31 January and 09 March 2020. We compared clinical characteristics and SARS-CoV-2 RNA shedding between patients initiated with LPV/r treatment and those without. Logistic regression analysis was employed to evaluate the risk factors associated with prolonged viral shedding. Results Of 120 patients, the median age was 52 years, 54 (45%) were male and 78 (65%) received LPV/r treatment. The median duration of SARS-CoV-2 RNA detection from symptom onset was 23 days (IQR, 18–32 days). Older age (odd ratio [OR] 1.03, 95% confidence interval [CI] 1.00–1.05, p=0.03) and the lack of LPV/r treatment (OR 2.42, 95% CI 1.10–5.36, p=0.029) were independent risk factors of prolonged SARS-CoV-2 RNA shedding. Patients who initiated LPV/r treatment within 10 days from symptom onset, but not initiated from day 11 onwards, had significantly shorter viral shedding duration compared with those without LPV/r treatment (median 19 days versus 28.5 days, Log-rank pConclusion Older age and the lack of LPV/r treatment were independently associated with prolonged SARS-CoV-2 RNA shedding in patients with COVID-19. Earlier administration of LPV/r treatment could shorten viral shedding duration.