Delayed Rise of Oral Fluid Antibodies, Elevated BMI, and Absence of Early Fever Correlate With Longer Time to SARS-CoV-2 RNA Clearance in a Longitudinally Sampled Cohort of COVID-19 Outpatients

Share this page:

Title

Delayed Rise of Oral Fluid Antibodies, Elevated BMI, and Absence of Early Fever Correlate With Longer Time to SARS-CoV-2 RNA Clearance in a Longitudinally Sampled Cohort of COVID-19 Outpatients

Subject

Description

Sustained molecular detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA in the upper respiratory tract (URT) in mild to moderate coronavirus disease 2019 (COVID-19) is common. We sought to identify host and immune determinants of prolonged SARS-CoV-2 RNA detection.

Date Last Updated (Year-Month-Day)

2021-04-16

Citation

Antar, Annukka A. R., Tong Yu, Nora Pisanic, Razvan Azamfirei, Jeffrey A. Tornheim, Diane M. Brown, Kate Kruczynski, Justin P. Hardick, Thelio Sewell, Minyoung Jang, Taylor Church, Samantha N. Walch, Carolyn Reuland, Vismaya S. Bachu, Kirsten Littlefield, Han-Sol Park, Rebecca L. Ursin, Abhinaya Ganesan, Oyinkansola Kusemiju, Brittany Barnaba, Curtisha Charles, Michelle Prizzi, Jaylynn R. Johnstone, Christine Payton, Weiwei Dai, Joelle Fuchs, Guido Massaccesi, Derek T. Armstrong, Jennifer L. Townsend, Sara C. Keller, Zoe O. Demko, Chen Hu, Mei-Cheng Wang, Lauren M. Sauer, Heba H. Mostafa, Jeanne C. Keruly, Shruti H. Mehta, Sabra L. Klein, Andrea L. Cox, Andrew Pekosz, Christopher D. Heaney, David L. Thomas, Paul W. Blair, and Yukari C. Manabe. 2021. "Delayed Rise of Oral Fluid Antibodies, Elevated BMI, and Absence of Early Fever Correlate With Longer Time to SARS-CoV-2 RNA Clearance in a Longitudinally Sampled Cohort of COVID-19 Outpatients." Open forum infectious diseases 8 (6).

Abstract

Background: Sustained molecular detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA in the upper respiratory tract (URT) in mild to moderate coronavirus disease 2019 (COVID-19) is common. We sought to identify host and immune determinants of prolonged SARS-CoV-2 RNA detection.

Methods: Ninety-five symptomatic outpatients self-collected midturbinate nasal, oropharyngeal (OP), and gingival crevicular fluid (oral fluid) samples at home and in a research clinic a median of 6 times over 1-3 months. Samples were tested for viral RNA, virus culture, and SARS-CoV-2 and other human coronavirus antibodies, and associations were estimated using Cox proportional hazards models.

Results: Viral RNA clearance, as measured by SARS-CoV-2 reverse transcription polymerase chain reaction (RT-PCR), in 507 URT samples occurred a median (interquartile range) 33.5 (17-63.5) days post-symptom onset. Sixteen nasal-OP samples collected 2-11 days post-symptom onset were virus culture positive out of 183 RT-PCR-positive samples tested. All participants but 1 with positive virus culture were negative for concomitant oral fluid anti-SARS-CoV-2 antibodies. The mean time to first antibody detection in oral fluid was 8-13 days post-symptom onset. A longer time to first detection of oral fluid anti-SARS-CoV-2 S antibodies (adjusted hazard ratio [aHR], 0.96; 95% CI, 0.92-0.99; P = .020) and body mass index (BMI) ≥25 kg/m2 (aHR, 0.37; 95% CI, 0.18-0.78; P = .009) were independently associated with a longer time to SARS-CoV-2 viral RNA clearance. Fever as 1 of first 3 COVID-19 symptoms correlated with shorter time to viral RNA clearance (aHR, 2.06; 95% CI, 1.02-4.18; P = .044).

Conclusions: We demonstrate that delayed rise of oral fluid SARS-CoV-2-specific antibodies, elevated BMI, and absence of early fever are independently associated with delayed URT viral RNA clearance.

Keywords: COVID-19; RT-PCR; SARS-CoV-2; antibody; viral RNA.

Accessibility

Open Source on Oxford Academic, © The Author(s) 2021. Published by Oxford University Press on behalf of Infectious Diseases Society of America.