Fred Hutchinson Cancer Center, Seattle, Washington, USA.
Centro de Investigaciones Tecnológicas, Biomédicas y Medioambientales, Universidad Nacional Mayor de San Marcos, Lima, Peru.
J Glob Health. 2023 Jun 23;13:06020. doi: 10.7189/jogh.13.06020.
Post-COVID conditions are characterised by persistent symptoms that negatively impact quality of life after SARS-CoV-2 diagnosis. While post-COVID risk factors and symptoms have been extensively described in localised regions, especially in the global north, post-COVID conditions remain poorly understood globally. The global, observational cohort study HVTN 405/HPTN 1901 characterises the convalescent course of SARS-CoV-2 infection among adults in North and South America and Africa.
We categorised the cohort by infection severity (asymptomatic, symptomatic, no oxygen requirement (NOR), non-invasive oxygen requirement (NIOR), invasive oxygen requirement (IOR)). We applied a regression model to assess correlations of demographics, co-morbidities, disease severity, and concomitant medications with COVID-19 symptom persistence and duration across global regions.
We enrolled 759 participants from Botswana, Malawi, South Africa, Zambia, Zimbabwe, Peru, and the USA a median of 51 (interquartile range (IQR) = 35-66) days post-diagnosis, from May 2020 to March 2021. 53.8% were female, 69.8% were 18-55 years old (median (md) = 44 years old, IQR = 33-58). Comorbidities included obesity (42.8%), hypertension (24%), diabetes (14%), human immunodeficiency virus (HIV) infection (11.6%) and lung disease (7.5%). 76.2% were symptomatic (NOR = 47.4%; NIOR = 22.9%; IOR = 5.8%). Median COVID-19 duration among symptomatic participants was 20 days (IQR = 11-35); 43.4% reported symptoms after COVID-19 resolution, 33.6% reported symptoms ≥30 days, 9.9% reported symptoms ≥60 days. Symptom duration correlated with disease severity (P < 0.001, NIOR vs NOR; P = 0.003, IOR vs NOR), lung disease (P = 0.001), race (P < 0.05, non-Hispanic Black vs White), and global region (P < 0.001). Prolonged viral shedding correlated with persistent abdominal pain (odds ratio (OR) = 5.51, P < 0.05) and persistent diarrhoea (OR = 6.64, P < 0.01).
Post-COVID duration varied with infection severity, race, lung disease, and region. Better understanding post-COVID conditions, including regionally-diverse symptom profiles, may improve clinical assessment and management globally.
Clinicaltrials.gov (#NCT04403880).
新冠后状况的特点是持续存在的症状，这些症状会对 SARS-CoV-2 诊断后的生活质量产生负面影响。虽然在局部地区（尤其是在全球北方）已经广泛描述了新冠后风险因素和症状，但全球范围内对新冠后状况的了解仍然很差。全球观察性队列研究 HVTN 405/HPTN 1901 描述了北美的成年人和非洲成年人在感染 SARS-CoV-2 后的康复过程。
我们根据感染严重程度（无症状、有症状、无吸氧需求（NOR）、非侵入性吸氧需求（NIOR）、侵入性吸氧需求（IOR））对队列进行分类。我们应用回归模型评估了人口统计学特征、合并症、疾病严重程度和伴随药物与全球各地区 COVID-19 症状持续时间和持续时间之间的相关性。
我们从 2020 年 5 月至 2021 年 3 月，从博茨瓦纳、马拉维、南非、赞比亚、津巴布韦、秘鲁和美国招募了 759 名参与者，中位时间为确诊后 51 天（四分位距（IQR）= 35-66 天）。53.8%为女性，69.8%年龄在 18-55 岁（中位数（md）= 44 岁，IQR= 33-58 岁）。合并症包括肥胖（42.8%）、高血压（24%）、糖尿病（14%）、人类免疫缺陷病毒（HIV）感染（11.6%）和肺部疾病（7.5%）。76.2%有症状（NOR= 47.4%；NIOR= 22.9%；IOR= 5.8%）。有症状参与者的 COVID-19 持续时间中位数为 20 天（IQR= 11-35）；43.4%报告在 COVID-19 缓解后有症状，33.6%报告症状持续≥30 天，9.9%报告症状持续≥60 天。症状持续时间与疾病严重程度相关（P<0.001，NIOR 与 NOR；P=0.003，IOR 与 NOR）、肺部疾病（P=0.001）、种族（P<0.05，非裔美国人与白人）和全球区域（P<0.001）。持续病毒脱落与持续腹痛（优势比（OR）=5.51，P<0.05）和持续腹泻（OR=6.64，P<0.01）相关。
新冠后持续时间因感染严重程度、种族、肺部疾病和地区而异。更好地了解新冠后状况，包括区域多样化的症状特征，可能会改善全球的临床评估和管理。
Clinicaltrials.gov（#NCT04403880）。
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