DOI: 10.1093/ofid/ofad612 ISSN: 2328-8957

A multinational case series describing successful treatment of persistent SARS-CoV-2 infection caused by Omicron sublineages with prolonged courses of nirmatrelvir/ritonavir.

Luke B Snell, Aimee McGreal-Bellone, Clemency Nye, Sarah Gage, Prijay Bakrania, Tom G S Williams, Emma Aarons, Alina Botgros, Samuel T Douthwaite, Patrick Mallon, Iain Milligan, Catherine Moore, Brendan O'Kelly, Jonathan Underwood, Eoghan de Barra, Gaia Nebbia
  • Infectious Diseases
  • Oncology


The optimum treatment for persistent infection with SARS-CoV-2 is not known. Our case series, across 5 hospitals in 3 countries, describes 11 cases where persistent SARS-CoV-2 infection was successfully treated with prolonged courses (median 10 days, range 10-18) of nirmatrelvir/ritonavir (Paxlovid). Most cases (9/11) had haematological malignancy and ten (10/11) had received CD20 depleting therapy. The median duration of infection was 103 days (IQR 85-138). The majority (10/11) were hospitalised, and seven (7/11) had severe/critical disease. All survived and 9/11 demonstrated viral clearance, almost half (4/9) of whom received nirmatrelvir/ritonavir as monotherapy. This case series suggests prolonged nirmatrelvir/ritonavir has a role in treating persistent infection.

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