J Med Virol . Lopinavir/ritonavir Is Associated With Pneumonia Resolution in COVID-19 Patients With Influenza Coinfection: A Retrospective Matched-Pair Cohort Study

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J Med Virol


. 2020 Jul 4.
doi: 10.1002/jmv.26260. Online ahead of print.
Lopinavir/ritonavir Is Associated With Pneumonia Resolution in COVID-19 Patients With Influenza Coinfection: A Retrospective Matched-Pair Cohort Study


Chong Yu ¹ , Zhiguo Zhang ² , Yujiao Guo ³ , Jing Shi ⁴ , Guangchang Pei ¹ , Ying Yao ¹ , Wenhui Liao ⁵ , Rui Zeng ¹



Affiliations

• PMID: 32621621
• DOI: 10.1002/jmv.26260

Abstract

Background: During the early stages of the pandemic, some coronavirus disease (COVID-19)patients were misdiagnosed as having influenza, which aroused the concern that some deaths attributed to influenza were actually COVID-19-related. Howerver, little is known about whether coinfection with influenza contributes to severity of COVID-19 pneumonia, and the optimal therapeutic strategy for these patients.
Methods: We retrospectively studied 128 hospitalized patients with COVID-19 pneumonia. All patients were positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)positive by nucleic acid detection. 64 cases were co-infected with influenza A/B and the other 64 were influenza negative, matched by age, sex, and days from onset of symptoms.
Results: Among the 64 co-infected patients, 54 (84.4%) were co-infected with influenza A, and 10 (15.6%) with influenza B. The median duration of viral shedding time from admission was longer for patients with influenza coinfection (17.0 days) than for those without influenza coinfection (12.0 days) (P<0.001). The multivariable Cox proportional hazards model showed that the hazard ratio HR of resolution in lung involvement was 1.878 (P=0.020) for patients administered lopinavir/ritonavir, compared with those not administered lopinavir/ritonavir (95% confidence interval (CI) 1.103, 3.196). Among influenza co-infected patients, those treated with lopinavir/ritonavir exhibited faster pneumonia resolution within two weeks after symptom onset (37% vs 1%, P=0.001).
Conclusions: There was no difference in lung involvement between influenza co-infected and non-infected groups. Lopinavir/ritonavir eliminated the difference of lung involvement between influenza co-infected and non-infected groups, indicating that lopinavir/ritonavir is associated with pneumonia resolution in COVID-19. This article is protected by copyright. All rights reserved.

Keywords: COVID-19; Influenza; Lopinavir/ritonavir; Pneumonia.