Rinki Deo, Manish C. Choudhary, Carlee Moser, Justin Ritz, Eric S. Daar, David A. Wohl, Alexander L. Greninger, Joseph J. Eron, Judith S. Currier, Michael D. Hughes, Davey M. Smith, Kara W. Chew, and Jonathan Z. Li for the ACTIV-2/A5401 Study Team
Jonathan Z. Li
Research Category: COVID-19
With the anecdotal reports of clinical relapse after Paxlovid treatment, it is important to understand the natural history of COVID-19 and underlying rates of viral and symptom rebound which is required to fully define the possible role that antiviral therapy may play in these observations. In this study, we evaluated the incidence of viral and symptom rebound in untreated outpatients with mild-moderate COVID-19 in the ACTIV-2/AIDS Clinical Trials Group A501 (A5401) multicenter phase 2/3 platform randomized trial. A key strength of this study includes the daily quantitative nasal viral load and symptom scores.
We observed that either viral RNA rebound or symptom score rebound is relatively common in participants who are not treated with any antiviral agents. However, the combination of viral and symptom rebound was uncommon. We also identified key characteristics of viral or symptom rebounders. These results provide insight into the natural trajectory of viral rebound and symptom relapses during COVID-19, which is critical in the interpretation of studies reporting biphasic disease courses after Paxlovid and other antiviral treatments