Lopinavir/ritonavir is associated with pneumonia resolution in COVID-19
patients with influenza coinfection:a retrospective matched-pair cohort
study
Abstract
Background: Little is known about whether coinfection of other
respiratory tract viruses contributes to severity of COVID-19 pneumonia.
Methods: We retrospectively studied 128 hospitalized patients with
COVID-19 pneumonia (64 cases co-infected with influenza A/B vs 64
negative influenza cases via pair-matching on age, sex, and days from
onset of symptom). Results: Among 64 co-infected patients, 54 patients
(84.4%) had co-infected with influenza A, and 10 (15.6%) with
influenza B. The percentages for the severity of pneumonia on admission
of the two groups, i.e., with influenza infection and without, were
similar (P=0.945). The median duration (days) of viral shedding time
from admission was longer for patients with influenza infection (17.0
day) than those without influenza infection (12.0 day)
(P<0.001). However, the progression of lung CT in four weeks
after onset of symptom were similar in both groups. The multivariable
Cox proportional hazards model showed that the HR of pneumonia
resolution on CT scans was 0.869 (P=0.612) for patients with influenza
(95% CI 0.505, 1.495) compared with patients without influenza, while
the HR of resolution in lung involvement was 1.878 (P=0.020) for
patients with lopinavir/ritonavir, compared with patients without
lopinavir/ritonavir (95% CI 1.103, 3.196). Patients who were treated
with lopinavir/ritonavir presented with faster pneumonia resolution in
two weeks after symptom onset both in the whole cohort (32.4% vs
13.8%, P=0.036) and in influenza co-infected group (37% vs 1%,
P=0.001). Conclusions: Lopinavir/ritonavir eliminated the difference of
lung involvement between influenza co-infected and non-infected groups,
indicating lopinavir/ritonavir is associated with pneumonia resolution
in COVID-19.