W.As COVID-19 infections become more common, experts recently urged Physicians should prescribe more of the antiviral drug paxlovid than ever before to minimize symptoms and reduce the likelihood of developing serious illness in patients. The drug is approved for people at high risk of developing severe her COVID-19, including older people and those with underlying medical conditions. However, many patients who took paxlovid reported developing rebound infections shortly thereafter. After initially supposedly clearing the infection and testing negative, he tested positive for the virus again. Studies have demonstrated that repeated positive reactions are not due to new infections, but to the same virus that caused the original infection. In 2022, the U.S. Centers for Disease Control and Prevention advised Physician about possible rebound infection; agency continues to recommend this drug for people at high risk of severe COVID-19 disease, but because people can be contagious when infection returns , doctors warned against rebounding.
The so-called “Paxlovid rebound” raises questions about how common rebound infections are with or without Paxlovid. study Drug rebound occurs in approximately 1.7% of paxlovid patients. This is slightly lower than that seen in the untreated placebo group.Larger studies have not yet established the frequency of rebound in infected, untreated people. Research published in Annals of internal medicine We shed some light on this issue by reporting how likely rebound infections are to occur if antivirals are not taken.
“When I heard reports of people saying they were getting better, [on Paxlovid] Dr. Jonathan Lee, Associate Professor of Medicine, Harvard Medical School and Brigham and Women’s Hospital, said: of research. “Only by understanding what happens in untreated infections can we interpret the data from patients receiving paxlobid.”
In this trial, which is part of a large clinical trial network testing various antiviral treatments for mild to moderate COVID-19 patients, Li conducted weekly nasal swabs in approximately 560 vaccinated people. We tracked measured symptoms and viral levels. Placebo during the course of infection. All had swabs taken at the beginning of the study and after 2, 3, and 4 weeks with a cotton swab. In addition, symptoms such as fever, headache, and cough were recorded daily.
About 26% of these untreated people reported recurrence of symptoms about 11 days after onset, and 31% had higher virus levels after an initial decline. reported both a recurrence of symptoms and an increase in viral load during the month-long study period. (All scenarios show rebound of infection.)
“These results show that improvement in symptoms is not a linear process, but actually increases and decreases over time,” says Li. “Also, it is rarely associated with high levels of viral rebound. Even without paxlobid…patients experience a rebound of symptoms and may also experience viral rebound.Paxlobid causes significant rebound side effects. When you say, you have to be careful when you don’t know yet.”
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Various studies and anecdotal data show that rebound rates differ significantly between paxlovid users and untreated people. For example, anecdotal reports suggest much higher rebound rates in people who took paxlovid than in the Pfizer study. , this variability between all studies could explain the differences. One advantage of the current study, Li said, was that patients were swabbed weekly.
So how should the results be interpreted?
Li says it’s most important to remember why people are taking Paxlovid. “Our reason for recommending Pax Lovid is not to prevent rebounds. [infections] to prevent hospitalizations and deaths,” he says. “When I counsel my patients, clinical trials [that the U.S. Food and Drug Administration reviewed to authorize Paxlovid] It showed 90% protection from hospitalization and death despite viral rebound after treatment. We need to keep an eye out for awards. Scientists are also looking into whether paxlovid can help reduce the risk of long-term COVID-19, but that research is still in its early stages and we can’t yet draw any conclusions.
Viral rebound infections are not uncommon. Researchers are learning more about why this particular virus bounces back after waning and how widespread repeat infections can be. Related to how paxlovid works, the recommended 5-day pill may not be enough to adequately suppress the virus, so stopping the medication may cause a relapse. In response to the system, the virus may be moving to different parts of the body and finding new cells to infect, causing viral levels to spike and symptoms to reappear. We need more focused data looking at both people taking paxlobid and those not taking it to better understand what is going on,” Lee says.
Determining who may benefit from paxlovid requires detailed discussions between doctors and patients, Li said. “I advise my patients according to their overall risk,” he says. “Risk factors such as age are not dichotomous yes/no answers. It’s a continuous spectrum. ”
Data from his study should help these debates to better balance the risks and benefits of treatment for individual patients. , which can spread the virus to others, more research is needed to clarify the rebound cycle.
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