학술논문
Predictors of SARS-CoV-2 RNA From Nasopharyngeal Swabs and Concordance With Other Compartments in Nonhospitalized Adults With Mild to Moderate COVID-19
Document Type
article
Author
Moser, Carlee; Li, Jonathan Z; Eron, Joseph J; Aga, Evgenia; Daar, Eric S; Wohl, David A; Coombs, Robert W; Javan, Arzhang Cyrus; Ignacio, Rachel A Bender; Jagannathan, Prasanna; Ritz, Justin; Sieg, Scott F; Parikh, Urvi M; Hughes, Michael D; Currier, Judith S; Smith, Davey M; Chew, Kara W; Hosey, Lara; Roa, Jhoanna; Patel, Nilam; Degli-Angeli, Emily; Goecker, Erin; Daza, Glenda; Harb, Socorro; Dragavon, Joan; Aldrovandi, Grace; Murtaugh, William; Cooper, Marlene; Gutzman, Howard; Knowles, Kevin; Bowman, Rachel; Erhardt, Bill; Adams, Stacey
Source
Open Forum Infectious Diseases. 9(11)
Subject
Language
Abstract
BackgroundIdentifying characteristics associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA shedding may be useful to understand viral compartmentalization, disease pathogenesis, and risks for viral transmission.MethodsParticipants were enrolled August 2020 to February 2021 in ACTIV-2/A5401, a placebo-controlled platform trial evaluating investigational therapies for mild-to-moderate coronavirus disease 2019 (COVID-19), and underwent quantitative SARS-CoV-2 RNA testing on nasopharyngeal and anterior nasal swabs, oral wash/saliva, and plasma at entry (day 0, pretreatment) and days 3, 7, 14, and 28. Concordance of RNA levels (copies/mL) across compartments and predictors of nasopharyngeal RNA levels were assessed at entry (n = 537). Predictors of changes over time were evaluated among placebo recipients (n = 265) with censored linear regression models.ResultsNasopharyngeal and anterior nasal RNA levels at study entry were highly correlated (r = 0.84); higher levels of both were associated with greater detection of RNA in plasma and oral wash/saliva. Older age, White non-Hispanic race/ethnicity, lower body mass index (BMI), SARS-CoV-2 immunoglobulin G seronegativity, and shorter prior symptom duration were associated with higher nasopharyngeal RNA at entry. In adjusted models, body mass index and race/ethnicity associations were attenuated, but the association with age remained (for every 10 years older, mean nasopharyngeal RNA was 0.27 log10 copies/mL higher; P < .001). Examining longitudinal viral RNA levels among placebo recipients, women had faster declines in nasopharyngeal RNA than men (mean change, -2.0 vs -1.3 log10 copies/mL, entry to day 3; P < .001).ConclusionsSARS-CoV-2 RNA shedding was concordant across compartments. Age was strongly associated with viral shedding, and men had slower viral clearance than women, which could explain sex differences in acute COVID-19 outcomes.