Have you been perplexed about why some immunocompromised (IC) patients recover from COVID-19 quickly while others can be infected for months? We uncovered some clues in a paper just published in @ScienceTM. Read on to see what we found: 1/ science.org/doi/10.1126/sc… Through our POSITIVES study with co-PIs Mark Siedner, Amy Barczak, Jake Lemieux, we enrolled 56 IC pts and 184 non-IC pts with intensive longitudinal sampling. IC pts were categorized into severe heme onc/transplant (S-HT), severe autoimmune (S-A), and non-severe (NS) groups 2/

Viral/symptom rebound after Paxlovid remains controversial with no consensus on whether Paxlovid rebound is real. If so, how common is it is? What are the risk factors and causes? Our POSITIVES study has some answers in a new paper in @AnnalsofIM! A🧵👇 acpjournals.org/doi/10.7326/M2… The FDA has stated that "there is not a clear association between Paxlovid treatment and COVID-19 rebound" () despite published cases and wide-spread reports in community. Why the disconnect? What data is the FDA relying upon? 2/fda.gov/media/155052/d…

Do you have a patient with persistent low-level HIV viremia and not sure why? We've got a new paper in @NatureMedicine exploring the reasons behind this phenomenon of non-suppressible viremia (NSV). Read on 👇 to hear about what we found! nature.com/articles/s4159… It all started when @sigal_md, a clinical colleague at @bwh_id, asked for our help with her patient with several yrs of persistent low-level viremia despite ART switches, intensification, good plasma ART drug levels and no significant drug resistance. 2/

Really concerned about the explosive growth of new non-BA.5 Omicron subvariants, especially BQ.1.1. This is especially bad news for our immunosuppressed patients and those who can't take Paxlovid. A quick 🧵 on why and how COVID-19 therapy will be affected 1/

https://twitter.com/EricTopol/status/1580926656755089408

For our immunosuppressed patients, Evusheld is the only prophylaxis drug available to prevent COVID-19. For those who can't take Paxlovid, Bebtelovimab is currently the preferred therapy in the NIH treatment guidelines as remdesivir is hard to dose 2/ covid19treatmentguidelines.nih.gov/therapies/anti…

Our peer-reviewed paper characterizing 7 cases of post-Paxlovid viral and symptom rebound is out in @CIDJournal with quantitative viral load, viral culture and whole genome sequencing data. 1/n academic.oup.com/cid/advance-ar… All pts were vax'd and boosted. All had symptom resolution and negative home-based rapid Ag testing after Paxlovid treatment. Symptoms recurred in 6/7 at a median of 4d after the end of treatment, associated with home Ag test+, high viral load and culture positivity in 3/7. 2/n

BA.2 is a sublineage of Omicron that's replacing the original BA.1 version in the U.S. I'll break down what we know about its effects on current antivirals and the facts behind #bebtelovimab, the newest anti-SARS-CoV-2 monoclonal antibody (mAb) that received FDA EUA. a🧵 1/ Compared to BA.1, BA.2 has quite a few changes to ORF1ab and the NTD region of Spike. Luckily, I don't see any mutations in nsp5 or 12 that would affect Paxlovid, remdesivir, or molnupiravir activity 2/

There's a lineage of Omicron that's gained the R346K mutation (BA.1.1). This one could spell some trouble for the AZ mAb (tixagevimab/cilgavimab, Evusheld) that's being used for pre-exposure prophylaxis. If you want to learn about tix/cil vs Omicron, read on 1/7

https://twitter.com/Unusual_Times/status/1487408125409902593

Tix/cil (Evusheld) are 2 mAbs that bind non-overlapping RBD epitopes + have Fc changes to make them long-lasting. In the ph3 PROVENT trial, tix/cil given to high-risk uninfected pts resulted in a 77% reduction in symptomatic COVID-19 infxn. It's FDA-authorized for PrEP 2/7

New preprint led by a very talented ID physician-scientist in my group @eeeejjjaaaa. He studied the effect of SARS-CoV-2 plasma viremia in a cohort of patients presenting to the Emergency Department w/ respiratory dysfxn. Huge thanks to @MGoldbergLab @arnavmehta3 + others 1/n

https://twitter.com/eeeejjjaaaa/status/1365728473445195778

While COVID is generally thought to be a pulmonary disease, 36% of participants had detectable SARS-CoV-2 RNA in plasma at the time of ED presentation. Viremia was associated with elevated inflammatory markers, lower lymphocyte counts, and signs of organ dysfunction 2/n