Journal article
Virological and serological characterization of critically ill patients with COVID-19 in the UK: interactions of viral load, antibody status and B.1.1.7 variant infection
- Abstract:
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Background
Convalescent plasma containing neutralizing antibody to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is under investigation for coronavirus disease 2019 (COVID-19) treatment. We report diverse virological characteristics of UK intensive care patients enrolled in the Immunoglobulin Domain of the REMAP-CAP randomized controlled trial that potentially influence treatment outcomes.
Methods
SARS-CoV-2 RNA in nasopharyngeal swabs collected pretreatment was quantified by PCR. Antibody status was determined by spike-protein ELISA. B.1.1.7 was differentiated from other SARS-CoV-2 strains using allele-specific probes or restriction site polymorphism (SfcI) targeting D1118H.
Results
Of 1274 subjects, 90% were PCR positive with viral loads 118–1.7 × 1011IU/mL. Median viral loads were 40-fold higher in those IgG seronegative (n = 354; 28%) compared to seropositives (n = 939; 72%). Frequencies of B.1.1.7 increased from <1% in November 2020 to 82% of subjects in January 2021. Seronegative individuals with wild-type SARS-CoV-2 had significantly higher viral loads than seropositives (medians 5.8 × 106 and 2.0 × 105 IU/mL, respectively; P = 2 × 10−15).
Conclusions
High viral loads in seropositive B.1.1.7-infected subjects and resistance to seroconversion indicate less effective clearance by innate and adaptive immune responses. SARS-CoV-2 strain, viral loads, and antibody status define subgroups for analysis of treatment efficacy.
- Publication status:
- Published
- Peer review status:
- Peer reviewed
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(Preview, Version of record, 1.7MB, Terms of use)
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- Publisher copy:
- 10.1093/infdis/jiab283
Authors
- Publisher:
- Oxford University Press
- Journal:
- The Journal of Infectious Diseases More from this journal
- Volume:
- 224
- Issue:
- 4
- Pages:
- 595–605
- Publication date:
- 2021-05-24
- Acceptance date:
- 2021-05-20
- DOI:
- EISSN:
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1537-6613
- ISSN:
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0022-1899
- Pmid:
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34031695
- Language:
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English
- Keywords:
- Pubs id:
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1178614
- Local pid:
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pubs:1178614
- Deposit date:
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2021-09-10
Terms of use
- Copyright holder:
- Ratcliff et al.
- Copyright date:
- 2021
- Rights statement:
- ©2021 The Author(s). Published by Oxford University Press for the Infectious Diseases Society of America. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/ by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. F
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