Virologic and Immunologic Characterization of Coronavirus Disease 2019 Recrudescence After Nirmatrelvir/Ritonavir Treatment

Aaron F Carlin; Alex E Clark; Antoine Chaillon; Aaron F Garretson; William Bray; Magali Porrachia; AsherLev T Santos; Tariq M Rana; Davey M Smith

doi:10.1093/cid/ciac496

Virologic and Immunologic Characterization of Coronavirus Disease 2019 Recrudescence After Nirmatrelvir/Ritonavir Treatment

Clin Infect Dis. 2023 Feb 8;76(3):e530-e532. doi: 10.1093/cid/ciac496.

Authors

Aaron F Carlin¹, Alex E Clark¹, Antoine Chaillon¹, Aaron F Garretson¹, William Bray², Magali Porrachia¹, AsherLev T Santos³, Tariq M Rana⁴, Davey M Smith^{1

5}

Affiliations

¹ Department of Medicine, University of California, San Diego School of Medicine, La Jolla, California, USA.
² Department of Pediatrics, University of California, San Diego School of Medicine, La Jolla, California, USA.
³ Department of Public Health, College of Education, Health and Human Services, California State University San Marcos, San Marcos, California, USA.
⁴ Division of Genetics, Department of Pediatrics, Program in Immunology, Institute for Genomic Medicine, UCSD Center for AIDS Research, University of California, San Diego, La Jolla, California, USA.
⁵ Veterans Affairs San Diego Healthcare System, San Diego, California, USA.

Abstract

We isolated a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) BA.2 variant from a person with coronavirus disease 2019 recrudescence after nirmatrelvir/ritonavir treatment. Antiviral sensitivity and neutralizing antibody testing were performed with both parental SARS-CoV-2 and multiple variants of concern. We found that neither nirmatrelvir resistance nor absence of neutralizing immunity was a likely cause of the recrudescence.

Keywords: COVID-19; COVID-19 recrudescence; Omicron; nirmatrelvir; treatment rebound.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

COVID-19 Drug Treatment
COVID-19*
Humans
Ritonavir / therapeutic use
SARS-CoV-2

Substances

Ritonavir

Grants and funding

K08 AI130381/AI/NIAID NIH HHS/United States