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- Title
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.
- Authors
Ratcliff, Jeremy; Nguyen, Dung; Fish, Matthew; Rynne, Jennifer; Jennings, Aislinn; Williams, Sarah; Al-Beidh, Farah; Bonsall, David; Evans, Amy; Golubchik, Tanya; Gordon, Anthony C; Lamikanra, Abigail; Tsang, Pat; Ciccone, Nick A; Leuscher, Ullrich; Slack, Wendy; Laing, Emma; Mouncey, Paul R; Ziyenge, Sheba; Oliveira, Marta
- Abstract
<bold>Background: </bold>Convalescent plasma containing neutralising antibody to SARS-CoV-2 is under investigation for COVID-19 treatment. We report diverse virological characteristics of UK intensive care patients enrolled in the Immunoglobulin Domain of the REMAP-CAP randomised controlled trial that potentially influence treatment outcomes.<bold>Methods: </bold>SARS-CoV-2 RNA in nasopharyngeal swabs collected pre-treatment 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.<bold>Results: </bold>Of 1274 subjects, 90% were PCR-positive with viral loads 118-1.7x10 11 IU/ml. Median viral loads were 40-fold higher in those seronegative for IgG antibodies (n=354; 28%) compared to seropositives (n=939; 72%). Frequencies of B.1.1.7 increased from <1% in early 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 5.8x10 6 and 2.0 x10 5 IU/ml respectively; p=2x10 -15). However, viral load distributions were elevated in both seronegative and seropositive subjects infected with B.1.1.7 (4.0x10 6 and 1.6x10 6 IU/ml respectively).<bold>Conclusions: </bold>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.
- Subjects
UNITED Kingdom; COVID-19; VIRAL load; SARS-CoV-2; CONVALESCENT plasma; CRITICALLY ill
- Publication
Journal of Infectious Diseases, 2021, Vol 224, Issue 4, p595
- ISSN
0022-1899
- Publication type
journal article
- DOI
10.1093/infdis/jiab283