The new results of the study indicate that different comorbid conditions affecting people diagnosed with COVID-19 may affect the time they continue to receive positive results from the SARS-CoV-2 polymerase chain reaction (PCR) test. People diagnosed with COVID-19 who are over 60 years of age, have three or more chronic medical conditions, especially diabetes, obesity, rheumatic disease, or an organ transplant, have positive PCR tests for longer periods of time compared to younger people without these comorbidities. However, the data did not show any significant difference in the duration of positive PCR test results for the degree of immunocompromise or for people receiving chemotherapy or steroids to treat COVID-19.
Published online at Open Forum Infectious Diseases and led by researchers at Boston Medical Center, this study is the largest sample size to date of the SARS-CoV-2 PCR test in both immunocompromised and non-immunocompromised patients, allowing comparison between these two groups. .
“Limited data on how long immunocompromised individuals continue test positive for COVID-19 after the initial infection, “said Rachel Epstein, MD, MScE, an infectious disease physician at Boston Medical Center and the corresponding author of the study.” This study questions whether current recommendations for considering re-testing severely immunocompromised individuals and using negative SARS -CoV-2 PCR testing results are needed to end isolation. “
According to the Centers for Disease Control and Prevention (CDC), people with severe immunocompromised are likely to have prolonged positive results on the SARS-CoV-2 PCR test. Conditions that cause the state of immunocompression represented in the CDC definition include: people on chemotherapy or high-dose steroids; those with untreated HIV; those with primary immunodeficiency; or those who recently received an organ transplant.
The researchers examined data from 3,758 individuals who were retested using the SARS-CoV-2 PCR test after an initial positive result. Individuals were separated into groups by age and immunocompromised severity:
- Active chemotherapy: severe, HIV with a CD4 count less than 200, organ transplant during the last year or chronic steroids at high doses (7.4% of the study group)
- Moderate: solid organ transplant recipient older than 1 year earlier, HIV with a CD4 count greater than 200 and others taking chronic biological drugs (4.2% of the study group)
- Non-immunocompromised (88.4% of the study group)
The mean duration of patients with severe immunocompromised to receive a negative SARS-CoV-2 PCR result was 22 days; for moderate and non-immunocompromised individuals, the time was 20 and 16 days, respectively. For people who had a solid organ transplantation, are over 60 years of age, have diabetes, obesity or rheumatic diseases, as well as those with more than three comorbid conditions; it took longer to obtain a negative result from the SARS-CoV-2 PCR test.
“Retesting individuals to end isolation precautions may delay attention and may not be necessary even for most severely immunocompromised people, especially because most transmission studies show that it is very rare. it is likely that someone will transmit the infection more than 20 days after their illness, ”Epstein said. , assistant professor of medicine and pediatrics at Boston University School of Medicine. The authors point out that re-testing recommendations should perhaps consider a combination of conditions or include only certain groups of people extremely immunocompromised individuals. There have been some cases in the literature showing positive COVID1-9 test results months later initial infection in patients who have undergone a solid organ or bone marrow transplant a receipt chimeric antigen receptor (CAR) T cell therapy.
Additional studies that directly measure the transmission or transmissibility of individuals with a positive PCR test result for more than 20 days in COVID-19 disease would be helpful in better informing current CDC guidelines.
Rachel L Epstein et al, Time to SARS-CoV-2 PCR clearance in immunocompromising conditions: is test-based based out of isolation in severely immunocompromised individuals ?, Open Forum Infectious Diseases (2021). DOI: 10.1093 / upset / ofab164
Boston Medical Center
Citation: Longer duration of positive results of the COVID-19 PCR test in people with certain comorbidities (2021, June 16) retrieved June 16, 2021 at https://medicalxpress.com/news/2021-06-longer -duration-positive-covid-pcr .html
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