A patient in the UK who had COVID-19 for a staggering 411 days was finally cleared of the infection after doctors sequenced the virus genome and targeted it with a personalized arsenal of drugs.
The incredible new case was the work of Dr Luke Blagdon Snell and colleagues from King’s College London and Guy’s and St Thomas’ NHS Foundation Trust.
The patient was a 59-year-old man with a weakened immune system following a kidney transplant. He had originally tested positive in December 2020 and continued to test positive right up until January 2022, despite receiving three doses of the COVID vaccine.
A detailed genetic analysis of the virus showed that the man had been infected with an early variant that ripped through the UK in the later months of 2020. It had then undergone multiple mutations since he was first infected.
Using this information, his doctors found mutations that made certain treatments ineffective and were then able to choose different options that would prove more effective. He was given a combination monoclonal antibody treatment called casirivimab/imdevimab. This treatment is no longer widely used because it is ineffective against newer variants, but since the man was infected with an earlier variant it proved successful.
The team used this targeted approach on a number of other troublesome cases.
In another example, a 45-year-old woman with HIV infection had failed to respond to treatment with casirivimab/imdevimab. A genetic analysis of the virus showed that it had picked up mutations that gave it resistance to these antibodies, so she was given antiviral Paxlovid treatment, which eventually cleared the virus.
Another case was a 60-year-old man who had a past medical history of blood cancer, and was close to death after testing positive for COVID-19 in April 2022. He was hospitalized multiple times, but no treatment appeared to be working.
On his fourth stay in the hospital, things took a turn for the worse and he was put on a ventilator. Doctors feared the worst, but in a last-ditch attempt, they analyzed the virus and gave him a combination that had not previously been tried or reported: Paxlovid and remdesivir.
Remarkably, it worked. His viral load dropped and he eventually no longer required extra oxygen. Weeks later, he was discharged from the hospital and remains in good health.
“This case suggests using two antivirals may successfully treat chronic COVID-19, which can occur in those with weakened immune systems who become persistently infected,” Dr Snell said in a statement.
“This is especially important now COVID variants have become resistant to the antibody therapies previously used to neutralize the virus. Further evidence is urgently needed to confirm the best treatments for persistent SARS-CoV-2 infection,” he added.
The new case study was reported in the journal Clinical Infectious Diseases this week.