1. Symptom and viral rebound uncommon after untreated COVID-19 infection
Combination of symptom and high-level viral rebound observed in only 3% of persons with COVID-19
Abstract: https://www.acpjournals.org/doi/10.7326/M22-2381
URL goes live when the embargo lifts
An analysis of a COVID-19 trial has found that a combination of symptom and viral rebound after untreated COVID-19 infection is rare, occurring in only 3 percent of study participants. The analysis is published in Annals of Internal Medicine.

Nirmatrelvir–ritonavir is a recommended treatment for outpatients with mild to moderate COVID-19 and risk factors for severe disease. Widespread use of nirmatrelvir has been accompanied by reports of worsening symptoms and virologic rebound after treatment completion. Virologic rebound has also been reported in persons who did not receive nirmatrelvir therapy, but studies that can define the frequencies of symptom and viral rebound during the natural course of COVID-19 are lacking.

Researchers from Brigham and Women’s Hospital conducted an analysis of 563 participants receiving placebo in the ACTIV-2/A5401 (Adaptive Platform Treatment Trial for Outpatients With COVID-19) platform trial. The authors found that a combination of symptom and high-level viral rebound occurred in only 3 percent of participants. Symptom rebound alone occurred in 26 percent of participants 11 days after initial symptom onset and viral rebound alone occurred in 31 percent of participants. High-level viral rebound was observed in 13 percent of participants. The researchers note that both symptom and viral rebound were short, lasting only one day in most participants. According to the authors, these results highlight the importance of accounting for underlying rates of symptom relapse in the absence of antiviral therapy when evaluating the effects of antiviral treatments.

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with the corresponding author Jonathan Z. Li, MD, please contact Haley Bridger at hbridger@bwh.harvard.edu or Nathan Astill at NAstill@mednet.ucla.edu.

Source: Symptom and viral rebound uncommon after untreated COVID-19 infection