Ritonavir, which has been used to boost HIV protease inhibitors, also can slow the metabolism of an assortment of other drugs, increasing blood concentrations too much. Nirmatrelvir is a protease inhibitor that blocks SARS-CoV-2 from replicating, while ritonavir boosts nirmatrelvir by slowing its metabolism in the liver. (High-risk patients who have mild to moderate COVID-19 but are hospitalized for other reasons are also eligible.)Ī 3-pill dose of Paxlovid consists of 2 nirmatrelvir pills and 1 ritonavir pill, which has no activity against SARS-CoV-2 on its own. Under its EUA, nirmatrelvir/ritonavir can be prescribed for mild to moderate COVID-19 in nonhospitalized patients aged 12 years or older who are at high risk of progression to severe disease due to age, obesity, cancer, or chronic diseases such as type 1 or type 2 diabetes. “There are more questions than answers,” Myron Cohen, MD, director of the University of North Carolina Institute for Global Health & Infectious Diseases in Chapel Hill and a leader of the National Institutes of Health’s COVID-19 Prevention Network, noted in an interview. However, the unexpected rebound phenomenon raises questions about how best to use this antiviral. In boldface type, the CDC’s health advisory says the agency continues to recommend nirmatrelvir/ritonavir for early treatment of mild to moderate COVID-19 among people at high risk of progression to severe disease, the population eligible for the drug under its Emergency Use Authorization (EUA), granted by the US Food and Drug Administration (FDA) in December 2021. No one is suggesting that people stop using the drug. “Is there something here? If there is, what is it, and what do we do about it?” Clifford Lane, MD, deputy director for clinical research and special projects at the National Institute of Allergy and Infectious Diseases, said in a recent interview. “I would say the anecdotes are pretty consistent and pretty pronounced,” H. COVID-19 rebound in people who’ve taken nirmatrelvir/ritonavir appears to be mild and short-lived, resolving, on average, in 3 days without additional anti-COVID-19 treatment, according to the advisory. In recent weeks, similar cases have been reported in the medical literature and on social media, prompting the Health Alert Network of the US Centers for Disease Control and Prevention (CDC) to issue a health advisory on May 24. “If you’re positive, you have to assume you’re infectious to others,” he explained. I’ve never seen this.’”Ī PCR test confirmed the positive rapid antigen test, and it was “back to jail” for Ho. “The initial shock was, ‘Wow, this is positive. “I tested myself immediately, and I was completely surprised that I was positive again,” Ho recalled. After testing negative again on day 5, he ended his isolation from his family but continued to test daily.Īfter 6 consecutive negative rapid antigen tests, plus a negative PCR test, Ho awoke feeling under the weather. By day 4, his symptoms had resolved and he tested negative for COVID-19. He immediately assumed that this was no cold, and a rapid antigen test followed by a polymerase chain reaction (PCR) test confirmed that he indeed had COVID-19.Ībout 12 hours after his symptoms arose, Ho swallowed his first dose of Pfizer’s antiviral nirmatrelvir/ritonavir, better known as Paxlovid. His throat hurt, his head ached, his nose was runny, and he felt even more fatigued than a healthy person should after a quick trip across the pond and back. Shortly after he returned home, Ho started coughing. They dined inside a restaurant, and the waitstaff weren’t wearing masks, Ho explained in an interview. He figures he most likely became infected at a preconference dinner for a small group of attendees. The irony is not lost on Ho, director of the Aaron Diamond AIDS Research Center at Columbia University. Shared Decision Making and Communication.Scientific Discovery and the Future of Medicine.Health Care Economics, Insurance, Payment.Clinical Implications of Basic Neuroscience.Challenges in Clinical Electrocardiography.
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