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COVID-19 Rebound: No Increased Risk with Antiviral Use

SUMMARY:

COVID-19 Rebound occurs between 2 – 8 days after the initial illness recovery and is described by the CDC as a recurrence of COVID-19 symptoms or a new positive viral test after having tested negative. High profile cases of COVID-19 rebound following the use of antiviral medications has led to growing concern that the use of these agents may prolong illness or paradoxically worsen outcomes. Two recent studies, one comparing symptomatic and viral rebound in untreated outpatients, and another examining differences in rebound rates of hospitalized patients, have shown reassuring results, with no increased risk of rebound due to antiviral use, and no increased morbidity or mortality associated with COVID-19 rebound.

KEY POINTS:

Annals of Internal Medicine

Outpatients with COVID-19
- Retrospective analysis of previous RCT
- 563 patients in the placebo arm were followed for symptom and viral (laboratory) rebound
- 13 different symptoms recorded daily during the study
- Patients underwent RNA testing on days 0 to 14, and then again on days 21 and 28
- Median onset of symptom rebound was on day 11 and occurred in 26% of participants
- Viral rebound occurred in 31% of participants
- Only 3% of participants had BOTH viral and symptom rebound
- Most rebounds were transient

The Lancet Infectious Diseases

Hospitalized patients with COVID-19 during the omicron wave in Hong Kong
- Retrospective study | Viral rebound and composite outcomes were assessed
- 4,592 patients who did not initially require supplemental oxygen
- 563 received Molnupiravir (Lagevrio)| 242 received Nirmatrelvir–Ritonavir (Paxlovid) | 3787 did not receive any oral antiviral treatment (control group)
- Viral burden rebound was observed in 4 to 7% of hospitalized patients and there was no statistically significant difference between each group
- Viral rebound was more common in certain groups: Younger adults (age 18–65 years) | Fully Vaccinated | Prior poor health | Immunocompromised | Patients on corticosteroids
- Viral rebound was not associated with increased adverse clinical outcomes
- Researchers in conclusion suspect that COVID-19 rebound may be due to the natural biphasic course of the disease or that the course of antiviral medications may not be adequate for certain patient populations (e.g., the immunocompromised)