Virological Characterization of Critically Ill Patients with COVID-19 in the United Kingdom: Interactions of Viral Load, Antibody Status, and B.1.1.7 Infection

REMAP-CAP Immunoglobulin Domain UK Investigators

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16 Citations (Scopus)

Abstract

Background. Convalescent plasma containing neutralizing antibody to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is under investigation for coronavirus disease 2019 (COVID-19) treatment. We report diverse virological characteristics of UK intensive care patients enrolled in the Immunoglobulin Domain of the REMAP-CAP randomized controlled trial that potentially influence treatment outcomes. Methods. SARS-CoV-2 RNA in nasopharyngeal swabs collected pretreatment was quantified by PCR. Antibody status was determined by spike-protein ELISA. B.1.1.7 was differentiated from other SARS-CoV-2 strains using allele-specific probes or restriction site polymorphism (SfcI) targeting D1118H. Results. Of 1274 subjects, 90% were PCR positive with viral loads 118-1.7 × 1011IU/mL. Median viral loads were 40-fold higher in those IgG seronegative (n = 354; 28%) compared to seropositives (n = 939; 72%). Frequencies of B.1.1.7 increased from < 1% in November 2020 to 82% of subjects in January 2021. Seronegative individuals with wild-type SARS-CoV-2 had significantly higher viral loads than seropositives (medians 5.8 × 106 and 2.0 × 105 IU/mL, respectively; P = 2 × 10-15). Conclusions. High viral loads in seropositive B.1.1.7-infected subjects and resistance to seroconversion indicate less effective clearance by innate and adaptive immune responses. SARS-CoV-2 strain, viral loads, and antibody status define subgroups for analysis of treatment efficacy.

Original languageEnglish
Pages (from-to)595-605
Number of pages11
JournalJournal of Infectious Diseases
Volume224
Issue number4
DOIs
Publication statusPublished - 15 Aug 2021
Externally publishedYes

Bibliographical note

Publisher Copyright:
© The Author(s) 2021.

Keywords

  • COVID-19
  • ELISA
  • SARS-CoV-2
  • clade B.1.1.7
  • convalescent plasma
  • coronavirus
  • polymerase chain reaction
  • randomized clinical trial
  • variant of concern
  • viral load

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