Delayed Rise of Oral Fluid Antibodies, Elevated BMI, and Absence of Early Fever Correlate With Longer Time to SARS-CoV-2 RNA Clearance in a Longitudinally Sampled Cohort of COVID-19 Outpatients. (16th April 2021)

• Record Type: Journal Article
• Authors: Antar, Annukka A R; Yu, Tong; Pisanic, Nora; Azamfirei, Razvan; Tornheim, Jeffrey A; Brown, Diane M; Kruczynski, Kate; Hardick, Justin P; Sewell, Thelio; Jang, Minyoung; Church, Taylor; Walch, Samantha N; Reuland, Carolyn; Bachu, Vismaya S; Littlefield, Kirsten; Park, Han-Sol; Ursin, Rebecca L; Ganesan, Abhinaya; Kusemiju, Oyinkansola; Barnaba, Brittany; Charles, Curtisha; Prizzi, Michelle; Johnstone, Jaylynn R; Payton, Christine; Dai, Weiwei; Fuchs, Joelle; Massaccesi, Guido; Armstrong, Derek T; Townsend, Jennifer L; Keller, Sara C; Demko, Zoe O; Hu, Chen; Wang, Mei-Cheng; Sauer, Lauren M; Mostafa, Heba H; Keruly, Jeanne C; Mehta, Shruti H; Klein, Sabra L; Cox, Andrea L; Pekosz, Andrew; Heaney, Christopher D; Thomas, David L; Blair, Paul W; Manabe, Yukari C;
• Is Part Of: Open forum infectious diseases. Volume 8:Number 6(2021)
• Publication Date: 2021-04-16
• Subjects: SARS-CoV-2 -- RT-PCR -- viral RNA -- COVID-19 -- antibody; Communicable diseases -- Periodicals; Medical microbiology -- Periodicals; Infection -- Periodicals; 616.9
• DOI: 10.1093/ofid/ofab195
• Languages: English
• ISSNs: 2328-8957

Abstract

Abstract: Background: Sustained molecular detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA in the upper respiratory tract (URT) in mild to moderate coronavirus disease 2019 (COVID-19) is common. We sought to identify host and immune determinants of prolonged SARS-CoV-2 RNA detection. Methods: Ninety-five symptomatic outpatients self-collected midturbinate nasal, oropharyngeal (OP), and gingival crevicular fluid (oral fluid) samples at home and in a research clinic a median of 6 times over 1–3 months. Samples were tested for viral RNA, virus culture, and SARS-CoV-2 and other human coronavirus antibodies, and associations were estimated using Cox proportional hazards models. Results: Viral RNA clearance, as measured by SARS-CoV-2 reverse transcription polymerase chain reaction (RT-PCR), in 507 URT samples occurred a median (interquartile range) 33.5 (17–63.5) days post–symptom onset. Sixteen nasal-OP samples collected 2–11 days post–symptom onset were virus culture positive out of 183 RT-PCR-positive samples tested. All participants but 1 with positive virus culture were negative for concomitant oral fluid anti-SARS-CoV-2 antibodies. The mean time to first antibody detection in oral fluid was 8–13 days post–symptom onset. A longer time to first detection of oral fluid anti-SARS-CoV-2 S antibodies (adjusted hazard ratio [aHR], 0.96; 95% CI, 0.92–0.99; P = .020) and body mass index (BMI) ≥25 kg/m 2 (aHR, 0.37; 95% CI, 0.18–0.78; P = .009) were independently associated with a longer time to SARS-CoV-2 viral RNA clearance. Fever as 1 of first 3 COVID-19 symptoms correlated with shorter time to viral RNA clearance (aHR, 2.06; 95% CI, 1.02–4.18; P = .044). Conclusions: We demonstrate that delayed rise of oral fluid SARS-CoV-2-specific antibodies, elevated BMI, and absence of early fever are independently associated with delayed URT viral RNA clearance.