Well, not really unexpected, but still:
Andreas Heyer, Thomas Günther, Alexis Robitaille et al., Remdesivir-induced emergence of SARS-CoV-2 variants in patients with prolonged infection. Cell Reports Medicine, August 2022. Doi: https://doi.org/10.1016/j.xcrm.2022.100735
From the press release, translation via deepl:
Antiviral treatment promotes the formation of new SARS-CoV-2 variants
A research team from the University Medical Center Hamburg-Eppendorf (UKE) and the Leibniz Institute of Virology (LIV) has investigated whether patients with long-lasting infections contribute to the emergence of new SARS-CoV-2 variants. They were able to show that it is not the long duration of infection per se that causes the formation of new variants, but rather that an evolutionary bottleneck is required, such as can be caused by antiviral treatment. The study was published in the renowned journal Cell Reports Medicine.
A team of scientists led by Prof. Dr. Nicole Fischer, Institute of Medical Microbiology, Virology and Hygiene at the UKE, and Prof. Dr. Adam Grundhoff, head of the LIV Virus Genomics Research Group, investigated whether patients with long-lasting SARS-CoV-2 infections generally exhibit increased viral evolution, which could enable the more rapid emergence of SARS-CoV-2 variants. Or whether certain treatment regimens promote the emergence of new mutations, especially when antiviral treatments, for example with remdesivir or convalescent plasma, exert selection pressure for the acquisition of escape mutations.
“Our work shows that it is not the long duration of infection per se that results in the formation of new variants, but rather that this requires an evolutionary bottleneck, such as can be created by antiviral treatment. This finding is particularly important in view of the recent discussions on the use of remdesivir for the treatment of non-hospitalized high-risk patients, but also for the introduction of potentially new antiviral therapeutics,” says Prof. Fischer.
Investigation of genomic diversity in long-lasting infections
In the study, the genomic diversity within the host was investigated in longitudinal samples from 14 patients with prolonged viral persistence (30 to 146 days) by whole genome sequencing during severe COVID-19 disease. This included immunocompromised and immunocompetent patients with or without antiviral treatment to evaluate the occurrence of mutations with and without selection pressure. Patients with prolonged SARS-CoV-2 infection and antiviral remdesivir treatment showed a significant increase in viral intra-host diversity with emerging mutations. In contrast, in patients receiving only anti-inflammatory treatment, the occurrence of new variants was observed only sporadically.
“Overall, the virus was surprisingly stable in the vast majority of individuals studied. However, in one patient treated with remdesivir, we observed that a high number of mutations occurred immediately after the start of treatment - including at least one mutation that is highly likely to confer increased resistance to remdesivir,” explains Prof. Grundhoff.
:
for COVID in 2022 to kill more people than it did in 2021.
