期刊
OPEN FORUM INFECTIOUS DISEASES
卷 8, 期 2, 页码 -出版社
OXFORD UNIV PRESS INC
DOI: 10.1093/ofid/ofab005
关键词
coronavirus; COVID-19; SARS-CoV-2; viral load; seroconversion; antibody responses; viral clearance
资金
- Plan Nacional Research + Development + Innovation (R+D+I) [RD16/0025/0038]
- Instituto de Salud Carlos III -Subdireccion General de Evaluacion y Fondo Europeo de Desarrollo Regional
- Instituto de Salud Carlos III (Fondo de Investigaciones Sanitarias) [PI16/01740, PI18/01861, COV20-00005]
The study found that viral replication determines the magnitude of antibody response to SARS-CoV-2 in COVID-19 patients, which contributes to viral clearance. Some patients are unable to produce antibodies, exhibiting different virological and clinical profiles.
Background. The interdependencies of viral replication and the host immune response in patients with coronavirus disease 2019 (COVID-19) remain to be defined. We investigated the viral determinants of antibody response, the predictors of nonseroconversion, and the role of antibodies on viral dynamics. Methods. This was a prospective study in patients hospitalized with COVID-19 that was microbiologically confirmed by real-time polymerase chain reaction (RT-PCR). Serial nasopharyngeal and oropharyngeal swabs and plasma samples were obtained for measuring severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA and antibodies (total and S-IgG/N-IgG), respectively. Results. Of 132 patients included, 99 (75%) showed positive antibody titers after a median (Q1-Q3) of 11 (8-14) days. The median (Q1-Q3) follow-up was 74.5 (63.0-87.0) days. In an adjusted linear regression model, time to seropositivity was inversely associated with peak log SARS-CoV-2 viral load (P = .009) and positively with time to viral clearance (P = .004). Adjusted predictors of S-IgG levels were time to viral clearance (P < .001), bilateral lung infiltrates on admission (P = .011), and the time-dependent SARS-CoV-2 RNA (P < .001) and SARS-CoV-2 RNA area under the curve (P = .001). Thirty-three (25%) patients showed undetectable antibody titers. Patients who did not seroconvert had higher cycle threshold values of RT-PCR (38.0 vs 28.0; P < .001), had shorter time to viral clearance (3.0 vs 41.0; P < .001), and were more likely to have SARS-CoV-2 only detected on fecal samples (P < .001). Nonseroconvertors had also lower levels of blood inflammatory biomarkers on admission and lower disease severity. Conclusions. Viral replication determines the magnitude of antibody response to SARS-CoV-2, which, in turn, contributes to viral clearance. COVID-19 patients who do not seroconvert exhibit a differential virological and clinical profile.
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