ABSTRACT
Background: The emergence of SARS-CoV-2 variants is a major concern. As the Delta variant became dominant worldwide, obtaining specific data on the humoral and cellular responses after BNT162b2 vaccination against this variant of concern in PLWHIV is crucial. Methods: Multicenter cohort study of PLWHIV, with a CD4 cell count <500/mm3 and a viral load <50 copies/ml on stable antiretroviral therapy for at least 3 months, to explore humoral and cellular responses to BNT162b2 vaccination. IgG antibodies (Ab) to the Receptor Binding Domain (RBD) of the spike protein and their neutralization capacity, assessed by an ELISA (Genscript) and a virus neutralization test (VNT), against historical strain, Beta and Delta variants were performed before vaccination (day 0) and one month after a complete vaccination schedule (M1). Results: 97 patients were enrolled in the study (table 1. baseline characteristics). Among them, 85 patients received 2 shots (11 previous COVID-19 and 1 premature exit). The median time between the 2 shots was 28 [IQR 28-29] days. 90 patients could be evaluated at M1. The seroconversion rate in anti-RBD IgG was 97% CI95%[90%;100%] at M1. Median (IQR) anti-RBD Ab titer was 0.97 (0.97-5.3) BAU/ml at D0 and 1219 (602-1929) at M1. Neutralizing Ab capacity improved between D0 (15% CI95%[8%;23%]) and M1 (94% CI95%[87%;98%]) with the Genscript assay. Neutralizing Ab with the VNT were present at M1 for historical strain, Beta and Delta variants in 82%, 77% and 84% patients respectively. Planned subgroups analysis at M1 showed that seroconversion rate and median anti-RBD Ab titer were 91% and 852 BAU/ml in patients with CD4<250/mm3 (n=13) and 98% and 1270 BAU/ml in patients with CD4>250/mm3 (n=64) (difference of change between D0 and M1 between subgroups p=0.8224). 73% of patients with CD4<250/mm3 had neutralizing Ab and 97% of those with CD4>250/mm3 (p=0.0130). The neutralization capacity of beta variant was 50% in CD4<250/mm3 and 81% in CD4>250/mm3 (p=0.0292). No change in CD4+ or CD8+ T cells count was observed while a decrease of CD19+ B cells count was observed (208 ±124/mm3 at D0 vs 188 ±112/mm3 at M1, p<0.01). Tolerance was very good and no COVID-19 was reported until M1. Conclusion: These results show a high seroconversion rate with a Delta neutralization in PLWHIV patients after a complete BNT162b2 vaccination schedule. However, patients with CD4<250/mm3 had a decrease neutralizing Ab capacity mainly against Beta than Delta variant.
ABSTRACT
BACKGROUND: To describe persistent symptoms in long COVID-19 non-severe outpatients and report the 6-month clinical recovery (CR) rate. METHODS: Observational study enrolling outpatients (≥ 18 years) with confirmed non-severe COVID-19 (positive nasopharyngeal RT-PCR or presence of SARS-CoV-2 antibodies) who consulted for persistent symptoms after the first pandemic wave (March-May 2020). CR was assessed at the 6-month visit and defined as complete (no symptom), partial (persistent symptoms of lower intensity) or lack of recovery (no improvement). RESULTS: Sixty-three patients (79% women, mean age: 48 years) enrolled; main symptoms (mean 81 days after acute infection): asthenia/myalgia (77%), dyspnea (51%), headaches (35%), cough (33%). At 6 months (n=56), 30% had complete, 57% partial, and 13% lack of recovery. The proportion of patients with>2 persistent symptoms was 26% at 6 months (main symptoms: dyspnea [54%] and asthenia/myalgia [46%]). CONCLUSION: We observed a slow but high recovery rate at 6 months among these outpatients.
Subject(s)
COVID-19 , Asthenia , COVID-19/complications , Dyspnea , Female , Follow-Up Studies , Humans , Male , Middle Aged , Myalgia , Outpatients , SARS-CoV-2 , Post-Acute COVID-19 SyndromeABSTRACT
OBJECTIVES: To describe the characteristics, evolution and risk factors for long-term persistence of olfactory and gustatory dysfunctions (OGD) in COVID-19 outpatients. PATIENTS AND METHODS: We conducted a prospective study in SARS-CoV-2 infected outpatients with OGD. Weekly phone interviews were set up starting from COVID-19 onset symptoms and over the course of 60 days, using standardized questionnaires that included a detailed description of general symptoms and OGD. The primary outcome was the proportion of patients with complete recovery of OGD at D30. Rate and time to recovery of OGD, as well as risk factors for late recovery (>30 days), were evaluated using Cox regression models. RESULTS: Ninety-eight outpatients were included. The median time to onset of OGD after first COVID-19 symptoms was 2 days (IQR 0-4). The 30-day recovery rate from OGD was 67.5% (95% CI 57.1-75.4) and the estimated median time of OGD recovery was 20 days (95% CI 13-26). Risk factors for late recovery of OGD were a complete loss of smell or taste at diagnosis (HR=0.26, 95% CI 0.12-0.56, P=0.0005) and age over 40 years (HR=0.56, 95% CI 0.36-0.89, P=0.01). CONCLUSIONS: COVID-19 patients with complete loss of smell or taste and over age 40 are more likely to develop persistent OGD and should rapidly receive sensorial rehabilitation.
Subject(s)
COVID-19/complications , Olfaction Disorders/etiology , Taste Disorders/etiology , Adult , Ambulatory Care , Cohort Studies , Female , Humans , Male , Middle Aged , Olfaction Disorders/epidemiology , Prospective Studies , Risk Factors , Taste Disorders/epidemiologyABSTRACT
Introduction. Persistent symptoms have recently emerged as a clinical issue in COVID-19. We aimed to assess the prevalence and risk factors in symptomatic non-hospitalized individuals with mild COVID-19. Methods. We performed a prospective cohort study of symptomatic COVID-19 outpatients, from March to May 2020, with weekly phone calls from clinical onset until day 30 and up to day 60 in case of persistent symptoms. The main outcomes were the proportion of patients with complete recovery at day 30 and day 60 and factors associated with persistent symptoms. Results. We enrolled 429 individuals mostly women (72.5%) and healthcare workers (72.5%), with a median age of 41.6 years [IQR 30-51.5]. Symptoms included: cough (69.7%), asthenia (68.8%), anosmia (64.8%), headaches (64.6%), myalgia (62.7%), gastrointestinal symptoms (61.8%), fever (61.5%), and ageusia (60.8%). Mean duration of disease was 27 days (95%CI: 25-29). The rate of persistent symptoms was 46.8% at day 30 and 6.5% at day 60 consisting in asthenia (32.6%), anosmia (32.6%), and ageusia (30.4%). The probability of complete recovery was 56.3% (95%CI: 51.7-61.1) at day 30 and 85.6% (95%CI: 81.2-89.4) at day 60. Factors associated with persistent symptoms were age >40 (HR 0.61), female sex (HR 0.70), low cycle threshold (HR 0.78), and ageusia (HR 0.59). Conclusions. COVID-19 — even in its mild presentation — led to persistent symptoms (up to one month) in nearly half of individuals. Identification of risk factors such as age, gender, ageusia and viral load is crucial for clinical management and argues for the development of antiviral agents.
ABSTRACT
Introduction La persistance d’une symptomatologie chez des patients suspects d’une infection à SARS-COV-2 est fréquente y compris chez des patients sans diagnostic virologique initial. L’organisation d’une consultation dite « post-COVID » initiée en mai 2020 et son évaluation constitue l’objectif de cette étude. Matériels et méthodes Étude rétrospective de cohorte des patients>18 ans, présentant une histoire clinique compatible avec une infection à SARS-COV-2, une symptomatologie persistante≥30 j du j0 et vus en consultation post-COVID entre mai–juin 2020. Le diagnostic d’infection à SARS-COV-2 a été définie par une RT-PCR SARS-COV-2 positive et/ou une sérologique positive en IgG (Architect, Abbott ;sensibilité 100 % [IC95 : 95,8–100 %] ;spécificité 99,6 % [IC95 : 99,0–99,9 %]). Les variables continues sont présentées en médiane et IQR. L’analyse présentée compare les caractéristiques des patients confirmés au SARS-COV-2 (COVID-19 positif) à ceux non confirmés (COVID-19 négatif). Résultats Un total de 83 patients (71 femmes [86 %], 46 ans [38–52]) ont consulté dans un délai 61jours (j) (49–78) après le début des symptômes. Les manifestations cliniques persistantes après j30 les plus fréquentes étaient : asthénie/myalgies (n=58, 70 %), toux (n=34, 41 %), dyspnée (n=45, 54 %) et douleur thoracique (n=43, 52 %). Parmi eux, 32/83 (39 %) avaient eu une PCR SARS-COV-2 positive et 51/83 (61 %) n’avait pas de preuve virologique d’infection. Une sérologie réalisée chez 78 patients (27 avec PCR positive antérieure et 51 sans preuve virologique) montre la présence d’Ac anti-SARS-CoV chez 37/78 (47 %) : 26/27 (97 %) des patients avec PCR initiale positive et 11/51 (22 %) des patients sans preuve virologique initiale. Au total, 43/83 (52 %) patients de la consultation post-COVID ont eu un COVID-19 confirmé. Le groupe COVID-19 positif (n=43, 33 femmes [77 %], 49 ans [44–59]) était significativement plus âgé (p=0,005) avec un délai de consultation plus court par rapport au j0 (55 j [45–70] vs 73 j [53–82], p=0,007) que les COVID-19 négatif (n=40, 29 femmes [73 %], 42 ans [35–49]) avec à j0, significativement plus souvent de la toux (n=36 [84 %] vs n=25 [63 %], p=0,028), une anosmie/dysgueusie (n=29 [67 %] vs n=8 [20 %], p<0,0001), des céphalées (n=26 [61 %] vs n=13 [33 %], p=0,010) et une hospitalisation plus fréquente (28 % vs 2,5 %, p=0,001). L’évolution clinique du groupe COVID-19 positif montrait la persistance majoritairement d’asthénie/myalgies (n=31, 72 %), toux et dyspnée (n=22, 51 %). Les manifestations d’anosmie/dysgueusie persistaient également et de façon significative par rapport au groupe COVID-19 négatif (n=10 [23 %] vs n=2 [5 %], p=0,020). Conclusion La consultation « post-COVID » a accueilli une moitié de patients confirmés au SARS-COV-2. Les manifestations les plus fréquemment rapportées étaient une asthénie, des myalgies et une symptomatologie pulmonaire. La sérologie SARS-COV-2 a permis un diagnostic rétrospectif d’infection au SARS-COV-2 chez 22 % des patients sans documentation virologique. La compréhension de cette persistance de symptômes cliniques nécessite une analyse clinicobiologique multidisciplinaire afin d’en adapter la prise en charge.