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Paxlovid Doesn’t Increase Risk for Rebound COVID Infection: Study

Editor’s note: Find the latest COVID-19 news and guidance in Medscape’s Coronavirus Resource Center.

People who took the antiviral Paxlovid to treat COVID-19 infections were not more likely to get back-to-back bouts of the virus, a new study shows.

The findings offer clarity amid concerns that the use of Paxlovid, which works by stopping the spread of the virus in the body, increased the risk of COVID-19 rebound.

“Rebound is a re-emergence of symptoms and an uptick in viral load after a period of recovery,” the Center for Infectious Disease Research and Policy explained in a summary of the study.

Researchers found that patients who received Paxlovid, another antiviral called Lagevrio, or no antiviral medication had rebounds at similar rates, ranging from 4.5% to 6.6%.

The study was published Monday in the journal The Lancet Infectious Diseases and included 4,592 people in Hong Kong who were hospitalized within 3 days of a COVID diagnosis. The study period was from Feb. 26, 2022, to July 3, 2022, which is the time that the Omicron subvariant BA.2.2 was predominant.

The study further found that the risk of rebound was tied to being 18 to 65 years old (compared to older patients), having chronic medical conditions, and receiving steroid treatment. Another finding, which the authors noted was important, was that it appeared Paxlovid did not make rebounds more severe. People who got Paxlovid and had a rebound infection were not more likely to be admitted to the intensive care unit, need a ventilator to help them breathe, or die.

In a commentary published alongside the study, infectious disease expert Nicola Petrosillo, MD, noted that an unexpected finding was the relationship between vaccination status and rebound.

“Surprisingly, the odds of viral burden rebound in patients receiving [Paxlovid] were significantly reduced in individuals who were not fully vaccinated,” he noted. 

Petrosillo, who treated some of the earliest COVID cases in Rome, said the takeaway from the study is the importance of continuing to offer antivirals to people at high risk of developing severe COVID. 


Center for Infectious Disease Research and Policy: “COVID antivirals not tied to rebound or worse outcomes.”

The Lancet Infectious Diseases: “Viral burden rebound in hospitalised patients with COVID-19 receiving oral antivirals in Hong Kong: a population-wide retrospective cohort study,” “SARS-CoV-2 rebound with and without antivirals.”

ContagionLive: “Fighting C Difficile Infection during the COVID-19 Pandemic.”

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  • Posted on February 15, 2023