The effect of lopinavir/ritonavir treatment
Of the 120 patients, 78 patients (65%) were administered LPV/r treatment. Patients receiving LPV/r treatment and those not receiving LPV/r treatment had similar baseline characteristics (table 3). However, patients receiving LPV/r treatment were more likely to have severe COVID-19 and a larger proportion of these patients had a lymphocyte count <0.8×109 cells·L−1, compared those without LPV/r treatment. LPV/r therapy was initiated at a median of 10 days (IQR 7–13 days) from symptom onset. Figure 2 shows the distribution of time to the initiation of LPV/r treatment from symptom onset. The median duration of LPV/r treatment was 10 days (IQR 9–10 days). 61 patients (78.2%) received ≥10 days of LRV/r treatment. The median duration of SARS-CoV-2 shedding in the LPV/r treatment group was 22 days (IQR 18–29 days), which was significantly shorter than that in the group with no LPV/r treatment (28.5 days, IQR 19.5–38 days; log-rank p=0.009) (supplementary figure E3). Patients who initiated LPV/r treatment within 10 days of symptom onset had a shorter duration of SARS-CoV-2 RNA shedding compared with those without LPV/r treatment (median 19 days versus 28.5 days; log-rank p<0.0001) (figure 3a). In contrast, the median duration of viral shedding did not differ between patients who initiated LPV/r treatment >10 days from symptom onset and patients who did not receive LPV/r treatment (median 27.5 days versus 28.5 days; log-rank p=0.51) (figure 3b).
TABLE 3 Comparison of clinical features of patients with SARS-CoV-2 infection who were treated with lopinavir/ritonavir (LPV/r) and without LPV/r, in Wuhan
Variable LPV/r No LPV/r p-value
Patients 78 42
Age years 50 (34–61) 57 (36.5–66) 0.11
Male sex 35 (44.9) 19 (45.2) 0.83
Current smoker 8 (10.3) 4 (9.5) 0.74
Comorbidity
 Hypertension 19 (24.4) 13 (31.0) 0.39
 Diabetes 8 (10.3) 2 (4.8) 0.49
 Cardiac disease# 5 (6.4) 2 (4.8) 1.00
 Stroke 2 (2.6) 1 (2.4) 1.00
 COPD or asthma 1 (1.3) 1 (2.4) 0.34
 Chronic renal insufficiency 1 (1.3) 0 (0)
 Malignancy 4 (5.1) 3 (7.1) 0.69
Disease severity 0.02
 General 53 (67.9) 36 (85.7)
 Severe 25 (32.1) 5 (11.9)
 Critical 0 (0) 1 (2.4)
Laboratory findings on admission
 White blood cell count ×109 cells·L−1 0.32
  <4 22 (28.2) 5 (11.9)
  4–10 49 (62.8) 33 (78.6)
  >10 7 (9.0) 3 (7.1)
 Lymphocyte count ×109 lymphocytes·L−1
  <0.8 25 (32.6) 4 (9.5) 0.01
 Platelet count ×109 platelets·L−1
  <100 6 (7.7) 1 (2.4) 0.42
 Creatinine level μmol·L−1
  >133 1 (1.3) 3 (7.1) 0.11
 AST level U·L−1
  >40 21 (26.9) 12 (28.6) 0.87
Treatment
 Corticosteroid therapy 44 (56.4) 10 (23.8) 0.001
 Antibiotics 73 (93.6) 30 (71.4) 0.001
 High-flow nasal canula oxygen therapy 17 (21.8) 4 (9.5) 0.13
 Noninvasive mechanical ventilation 1 (1.3) 1 (2.4) 1.00
 Invasive mechanical ventilation 1 (1.3) 0 (0) 1.00
Outcome
 Viral shedding days 22 (18–29) 28.5 (19.5–38) 0.02
 Hospital length of stay days 23 (19–27) 18.5 (13–22.5) <0.01
Data are presented as n, median (interquartile range) or n (%), unless otherwise stated. AST: aspartate aminotransferase. #: includes congestive heart disease and coronary atherosclerotic heart disease.
FIGURE 2 Distribution of time to the initiation of lopinavir/ritonavir (LPV/r) treatment from symptom onset.
FIGURE 3 The cumulative proportions of patients with detectable SARS-CoV-2 RNA over time, by day after symptom onset, comparing patients without lopinavir/ritonavir (LPV/r) treatment with a) patients initiating LPV/r treatment <10 days from symptom onset, and b) patients initiating LPV/r treatment >10 days from symptom onset.