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  Conference on Retroviruses
and Opportunistic Infections
February 12-16, 2022
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COVID Symptoms Reported Lasting
Longer in US Than South Africa, Peru
  2022 CROI, February 12-16 and 22-24, 2022
Mark Mascolini
One third of people in a US-Peru-Africa study had at least one COVID symptom that lasted more than 28 days, and 17% had at least one symptom that lingered longer than 42 days [1]. The HVTN 405/HPTN 1901 study also found higher symptom persistence rates reported in the United States than in Peru or South Africa.
Available research suggests COVID-19 symptoms persist in 80% of people more than 2 weeks after acute infection. But sorting out the meaning of symptom persistence studies can be difficult because case definitions differ and studies often do not compare inpatients with outpatients or high-income with low-income countries.
HVTN 405/HPTN 1901 is a multicountry observational cohort aiming to chart the clinical and immunologic course of SARS-CoV-2 infection [2]. The 759 participants live in Peru, the United States, South Africa, Zimbabwe, Zambia, and Malawi. This presentation groups the last three countries as "non-RSA" (non-Republic of South Africa). The investigators considered four levels of COVID severity: asymptomatic (24% of cohort), symptomatic no oxygen (47%), symptomatic noninvasive oxygen (23%), and symptomatic invasive oxygen/intubation (6%).
Of the 759 participants, 191 lived in Peru, 197 in the US, 286 in South Africa, and 85 in non-RSA African countries. Overall median age stood at 44 and was highest in the US at 51. Women made up 54% of the study group, blacks 43%, Latinx 28%, whites 16%, and other races/ethnicities 14%. While 43% of the study group was obese (highest in South Africa at 52%), 24% had hypertension, 14% diabetes, and 12% HIV infection (highest in US at 15%).
The researchers selected 22 COVID symptoms to analyze. Symptom frequency was highest with fatigue in 18%, followed by cough in 13%, exertional shortness of breath in 13%, chest pain in 9%, muscle pain in 8%, loss of smell in 7%, headache in 7%, and diminished taste in 7%.
Slightly more than one third of study members, 34.5%, reported one or more symptom that persisted more than 28 days after onset. A significantly higher proportion of people who needed invasive oxygen than symptomatic people who did not need oxygen reported one or more symptoms lasting more than 28 days (P < 0.001). This symptom persistence was most frequent in the US (53%), followed by non-RSA Africa (42%), South Africa (28%), then Peru (21%) (overall P < 0.001).
One or more symptoms persisted more than 42 days after onset in 16.8% of participants, including a significantly higher proportion who needed noninvasive oxygen (24%) versus no oxygen (14%) (P = 0.025). Again the US had the highest proportion of participants with symptoms that lasted this long (28%) compared with non-RSA Africa (25%), South Africa (13%), and Peru (6%) (overall P < 0.001).
Symptoms persisted a median of 24.5 days in people who needed invasive oxygen, 26 days in those who needed noninvasive oxygen, and 16 days in those who did not need oxygen. Geometric mean ratio indicated a significantly longer symptom duration in people who needed noninvasive oxygen than in symptomatic people who did not need oxygen (GMR 1.38, P < 0.001).
Median symptom duration stood at 30 days in the US, 25 days in non-RSA African countries, 17 days in South Africa, and 16 days in Peru. Geometric mean ratios indicated significantly longer symptom duration in the US than in Peru (GMR 1.40, P < 0.001) and in non-RSA Africa than in Peru (GMR 1.26, P < 0.05).
The HVTN/HPTN researchers speculated that regional differences in symptom duration could reflect viral diversity, host genetics, cultural factors (such as different perceptions of pain), disparities in healthcare access, and different treatments.
1. Gallardo-Cartagena JA, Montenegro-Idrogo JJ, Li S, et al. Symptom duration in COVID-19 convalescent patients: regional and clinical associations. 2022 CROI, February 12-16 and 22-24, 2022. Abstract 97.
2. ClinicalTrials.gov. Characterizing SARS-CoV-2-specific immunity in individuals who have recovered From COVID-19. ClinicalTrials.gov identifier NCT04403880. https://clinicaltrials.gov/ct2/show/NCT04403880