Lopinavir-ritonavir versus hydroxychloroquine for viral clearance and clinical improvement in patients with mild to moderate coronavirus disease 2019.
Identifieur interne : 001411 ( Main/Corpus ); précédent : 001410; suivant : 001412Lopinavir-ritonavir versus hydroxychloroquine for viral clearance and clinical improvement in patients with mild to moderate coronavirus disease 2019.
Auteurs : Ji-Won Kim ; Eun Jin Kim ; Hyun Hee Kwon ; Chi Young Jung ; Kyung Chan Kim ; Jung-Yoon Choe ; Hyo-Lim HongSource :
- The Korean journal of internal medicine [ 2005-6648 ] ; 2021.
English descriptors
- KwdEn :
- Aged (MeSH), Aged, 80 and over (MeSH), Antiviral Agents (adverse effects), Antiviral Agents (therapeutic use), COVID-19 (diagnosis), COVID-19 (drug therapy), COVID-19 (virology), Drug Combinations (MeSH), Female (MeSH), Humans (MeSH), Hydroxychloroquine (adverse effects), Hydroxychloroquine (therapeutic use), Lopinavir (adverse effects), Lopinavir (therapeutic use), Male (MeSH), Middle Aged (MeSH), Retrospective Studies (MeSH), Ritonavir (adverse effects), Ritonavir (therapeutic use), SARS-CoV-2 (drug effects), SARS-CoV-2 (pathogenicity), Time Factors (MeSH), Treatment Outcome (MeSH), Viral Load (MeSH).
- MESH :
- chemical , adverse effects : Antiviral Agents, Hydroxychloroquine, Lopinavir, Ritonavir.
- chemical , therapeutic use : Antiviral Agents, Hydroxychloroquine, Lopinavir, Ritonavir.
- diagnosis : COVID-19.
- drug effects : SARS-CoV-2.
- drug therapy : COVID-19.
- pathogenicity : SARS-CoV-2.
- virology : COVID-19.
- Aged, Aged, 80 and over, Drug Combinations, Female, Humans, Male, Middle Aged, Retrospective Studies, Time Factors, Treatment Outcome, Viral Load.
Abstract
BACKGROUND/AIMS
The efficacies of lopinavir-ritonavir or hydroxychloroquine remain to be determined in patients with coronavirus disease 2019 (COVID-19). To compare the virological and clinical responses to lopinavir-ritonavir and hydroxychloroquine treatment in COVID-19 patients.
METHODS
This retrospective cohort study included patients with COVID-19 treated with lopinavir-ritonavir or hydroxychloroquine at a single center in Korea from February 17 to March 31, 2020. Patients treated with lopinavir-ritonavir and hydroxychloroquine concurrently and those treated with lopinavir-ritonavir or hydroxychloroquine for less than 7 days were excluded. Time to negative conversion of viral RNA, time to clinical improvement, and safety outcomes were assessed after 6 weeks of follow-up.
RESULTS
Of 65 patients (mean age, 64.3 years; 25 men [38.5%]), 31 were treated with lopinavir-ritonavir and 34 were treated with hydroxychloroquine. The median duration of symptoms before treatment was 7 days and 26 patients (40%) required oxygen support at baseline. Patients treated with lopinavir-ritonavir had a significantly shorter time to negative conversion of viral RNA than those treated with hydroxychloroquine (median, 21 days vs. 28 days). Treatment with lopinavir-ritonavir (adjusted hazard ratio [aHR], 2.28; 95% confidence interval [CI], 1.24 to 4.21) and younger age (aHR, 2.64; 95% CI 1.43 to 4.87) was associated with negative conversion of viral RNA. There was no significant difference in time to clinical improvement between lopinavir-ritonavir- and hydroxychloroquine-treated patients (median, 18 days vs. 21 days). Lymphopenia and hyperbilirubinemia were more frequent in lopinavir-ritonavir-treated patients compared with hydroxychloroquine-treated patients.
CONCLUSION
Lopinavir-ritonavir was associated with more rapid viral clearance than hydroxychloroquine in mild to moderate COVID-19, despite comparable clinical responses. These findings should be confirmed in randomized, controlled trials.
DOI: 10.3904/kjim.2020.224
PubMed: 32536150
PubMed Central: PMC8009163
Links to Exploration step
pubmed:32536150Le document en format XML
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Kwon</name><affiliation><nlm:affiliation>Divisions of Infectious Diseases, Department of Internal Medicine, Daegu Catholic University School of Medicine, Daegu, Korea.</nlm:affiliation></affiliation></author><author><name sortKey="Jung, Chi Young" sort="Jung, Chi Young" uniqKey="Jung C" first="Chi Young" last="Jung">Chi Young Jung</name><affiliation><nlm:affiliation>Divisions of Pulmonology, Department of Internal Medicine, Daegu Catholic University School of Medicine, Daegu, Korea.</nlm:affiliation></affiliation></author><author><name sortKey="Kim, Kyung Chan" sort="Kim, Kyung Chan" uniqKey="Kim K" first="Kyung Chan" last="Kim">Kyung Chan Kim</name><affiliation><nlm:affiliation>Divisions of Pulmonology, Department of Internal Medicine, Daegu Catholic University School of Medicine, Daegu, Korea.</nlm:affiliation></affiliation></author><author><name sortKey="Choe, Jung Yoon" sort="Choe, Jung Yoon" uniqKey="Choe J" first="Jung-Yoon" last="Choe">Jung-Yoon Choe</name><affiliation><nlm:affiliation>Divisions of Rheumatology, Department of Internal Medicine, Daegu Catholic University School of Medicine, Daegu, Korea.</nlm:affiliation></affiliation></author><author><name sortKey="Hong, Hyo Lim" sort="Hong, Hyo Lim" uniqKey="Hong H" first="Hyo-Lim" last="Hong">Hyo-Lim Hong</name><affiliation><nlm:affiliation>Divisions of Infectious Diseases, Department of Internal Medicine, Daegu Catholic University School of Medicine, Daegu, Korea.</nlm:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PubMed</idno><date when="2021">2021</date><idno type="RBID">pubmed:32536150</idno><idno type="pmid">32536150</idno><idno type="doi">10.3904/kjim.2020.224</idno><idno type="pmc">PMC8009163</idno><idno type="wicri:Area/Main/Corpus">001411</idno><idno type="wicri:explorRef" wicri:stream="Main" wicri:step="Corpus" wicri:corpus="PubMed">001411</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en">Lopinavir-ritonavir versus hydroxychloroquine for viral clearance and clinical improvement in patients with mild to moderate coronavirus disease 2019.</title><author><name sortKey="Kim, Ji Won" sort="Kim, Ji Won" uniqKey="Kim J" first="Ji-Won" last="Kim">Ji-Won Kim</name><affiliation><nlm:affiliation>Divisions of Rheumatology, Department of Internal Medicine, Daegu Catholic University School of Medicine, Daegu, Korea.</nlm:affiliation></affiliation></author><author><name sortKey="Kim, Eun Jin" sort="Kim, Eun Jin" uniqKey="Kim E" first="Eun Jin" last="Kim">Eun Jin Kim</name><affiliation><nlm:affiliation>Divisions of Pulmonology, Department of Internal Medicine, Daegu Catholic University School of Medicine, Daegu, Korea.</nlm:affiliation></affiliation></author><author><name sortKey="Kwon, Hyun Hee" sort="Kwon, Hyun Hee" uniqKey="Kwon H" first="Hyun Hee" last="Kwon">Hyun Hee Kwon</name><affiliation><nlm:affiliation>Divisions of Infectious Diseases, Department of Internal Medicine, Daegu Catholic University School of Medicine, Daegu, Korea.</nlm:affiliation></affiliation></author><author><name sortKey="Jung, Chi Young" sort="Jung, Chi Young" uniqKey="Jung C" first="Chi Young" last="Jung">Chi Young Jung</name><affiliation><nlm:affiliation>Divisions of Pulmonology, Department of Internal Medicine, Daegu Catholic University School of Medicine, Daegu, Korea.</nlm:affiliation></affiliation></author><author><name sortKey="Kim, Kyung Chan" sort="Kim, Kyung Chan" uniqKey="Kim K" first="Kyung Chan" last="Kim">Kyung Chan Kim</name><affiliation><nlm:affiliation>Divisions of Pulmonology, Department of Internal Medicine, Daegu Catholic University School of Medicine, Daegu, Korea.</nlm:affiliation></affiliation></author><author><name sortKey="Choe, Jung Yoon" sort="Choe, Jung Yoon" uniqKey="Choe J" first="Jung-Yoon" last="Choe">Jung-Yoon Choe</name><affiliation><nlm:affiliation>Divisions of Rheumatology, Department of Internal Medicine, Daegu Catholic University School of Medicine, Daegu, Korea.</nlm:affiliation></affiliation></author><author><name sortKey="Hong, Hyo Lim" sort="Hong, Hyo Lim" uniqKey="Hong H" first="Hyo-Lim" last="Hong">Hyo-Lim Hong</name><affiliation><nlm:affiliation>Divisions of Infectious Diseases, Department of Internal Medicine, Daegu Catholic University School of Medicine, Daegu, Korea.</nlm:affiliation></affiliation></author></analytic><series><title level="j">The Korean journal of internal medicine</title><idno type="eISSN">2005-6648</idno><imprint><date when="2021" type="published">2021</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Aged (MeSH)</term><term>Aged, 80 and over (MeSH)</term><term>Antiviral Agents (adverse effects)</term><term>Antiviral Agents (therapeutic use)</term><term>COVID-19 (diagnosis)</term><term>COVID-19 (drug therapy)</term><term>COVID-19 (virology)</term><term>Drug Combinations (MeSH)</term><term>Female (MeSH)</term><term>Humans (MeSH)</term><term>Hydroxychloroquine (adverse effects)</term><term>Hydroxychloroquine (therapeutic use)</term><term>Lopinavir (adverse effects)</term><term>Lopinavir (therapeutic use)</term><term>Male (MeSH)</term><term>Middle Aged (MeSH)</term><term>Retrospective Studies (MeSH)</term><term>Ritonavir (adverse effects)</term><term>Ritonavir (therapeutic use)</term><term>SARS-CoV-2 (drug effects)</term><term>SARS-CoV-2 (pathogenicity)</term><term>Time Factors (MeSH)</term><term>Treatment Outcome (MeSH)</term><term>Viral Load (MeSH)</term></keywords><keywords scheme="MESH" type="chemical" qualifier="adverse effects" xml:lang="en"><term>Antiviral Agents</term><term>Hydroxychloroquine</term><term>Lopinavir</term><term>Ritonavir</term></keywords><keywords scheme="MESH" type="chemical" qualifier="therapeutic use" xml:lang="en"><term>Antiviral Agents</term><term>Hydroxychloroquine</term><term>Lopinavir</term><term>Ritonavir</term></keywords><keywords scheme="MESH" qualifier="diagnosis" xml:lang="en"><term>COVID-19</term></keywords><keywords scheme="MESH" qualifier="drug effects" xml:lang="en"><term>SARS-CoV-2</term></keywords><keywords scheme="MESH" qualifier="drug therapy" xml:lang="en"><term>COVID-19</term></keywords><keywords scheme="MESH" qualifier="pathogenicity" xml:lang="en"><term>SARS-CoV-2</term></keywords><keywords scheme="MESH" qualifier="virology" xml:lang="en"><term>COVID-19</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Aged</term><term>Aged, 80 and over</term><term>Drug Combinations</term><term>Female</term><term>Humans</term><term>Male</term><term>Middle Aged</term><term>Retrospective Studies</term><term>Time Factors</term><term>Treatment Outcome</term><term>Viral Load</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p><b>BACKGROUND/AIMS</b></p><p>The efficacies of lopinavir-ritonavir or hydroxychloroquine remain to be determined in patients with coronavirus disease 2019 (COVID-19). To compare the virological and clinical responses to lopinavir-ritonavir and hydroxychloroquine treatment in COVID-19 patients.</p></div><div type="abstract" xml:lang="en"><p><b>METHODS</b></p><p>This retrospective cohort study included patients with COVID-19 treated with lopinavir-ritonavir or hydroxychloroquine at a single center in Korea from February 17 to March 31, 2020. Patients treated with lopinavir-ritonavir and hydroxychloroquine concurrently and those treated with lopinavir-ritonavir or hydroxychloroquine for less than 7 days were excluded. Time to negative conversion of viral RNA, time to clinical improvement, and safety outcomes were assessed after 6 weeks of follow-up.</p></div><div type="abstract" xml:lang="en"><p><b>RESULTS</b></p><p>Of 65 patients (mean age, 64.3 years; 25 men [38.5%]), 31 were treated with lopinavir-ritonavir and 34 were treated with hydroxychloroquine. The median duration of symptoms before treatment was 7 days and 26 patients (40%) required oxygen support at baseline. Patients treated with lopinavir-ritonavir had a significantly shorter time to negative conversion of viral RNA than those treated with hydroxychloroquine (median, 21 days vs. 28 days). Treatment with lopinavir-ritonavir (adjusted hazard ratio [aHR], 2.28; 95% confidence interval [CI], 1.24 to 4.21) and younger age (aHR, 2.64; 95% CI 1.43 to 4.87) was associated with negative conversion of viral RNA. There was no significant difference in time to clinical improvement between lopinavir-ritonavir- and hydroxychloroquine-treated patients (median, 18 days vs. 21 days). Lymphopenia and hyperbilirubinemia were more frequent in lopinavir-ritonavir-treated patients compared with hydroxychloroquine-treated patients.</p></div><div type="abstract" xml:lang="en"><p><b>CONCLUSION</b></p><p>Lopinavir-ritonavir was associated with more rapid viral clearance than hydroxychloroquine in mild to moderate COVID-19, despite comparable clinical responses. These findings should be confirmed in randomized, controlled trials.</p></div></front></TEI><pubmed><MedlineCitation Status="MEDLINE" Owner="NLM"><PMID Version="1">32536150</PMID><DateCompleted><Year>2021</Year><Month>03</Month><Day>25</Day></DateCompleted><DateRevised><Year>2021</Year><Month>04</Month><Day>03</Day></DateRevised><Article PubModel="Print-Electronic"><Journal><ISSN IssnType="Electronic">2005-6648</ISSN><JournalIssue CitedMedium="Internet"><Volume>36</Volume><Issue>Suppl 1</Issue><PubDate><Year>2021</Year><Month>03</Month></PubDate></JournalIssue><Title>The Korean journal of internal medicine</Title><ISOAbbreviation>Korean J Intern Med</ISOAbbreviation></Journal><ArticleTitle>Lopinavir-ritonavir versus hydroxychloroquine for viral clearance and clinical improvement in patients with mild to moderate coronavirus disease 2019.</ArticleTitle><Pagination><MedlinePgn>S253-S263</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.3904/kjim.2020.224</ELocationID><Abstract><AbstractText Label="BACKGROUND/AIMS">The efficacies of lopinavir-ritonavir or hydroxychloroquine remain to be determined in patients with coronavirus disease 2019 (COVID-19). To compare the virological and clinical responses to lopinavir-ritonavir and hydroxychloroquine treatment in COVID-19 patients.</AbstractText><AbstractText Label="METHODS">This retrospective cohort study included patients with COVID-19 treated with lopinavir-ritonavir or hydroxychloroquine at a single center in Korea from February 17 to March 31, 2020. Patients treated with lopinavir-ritonavir and hydroxychloroquine concurrently and those treated with lopinavir-ritonavir or hydroxychloroquine for less than 7 days were excluded. Time to negative conversion of viral RNA, time to clinical improvement, and safety outcomes were assessed after 6 weeks of follow-up.</AbstractText><AbstractText Label="RESULTS">Of 65 patients (mean age, 64.3 years; 25 men [38.5%]), 31 were treated with lopinavir-ritonavir and 34 were treated with hydroxychloroquine. The median duration of symptoms before treatment was 7 days and 26 patients (40%) required oxygen support at baseline. Patients treated with lopinavir-ritonavir had a significantly shorter time to negative conversion of viral RNA than those treated with hydroxychloroquine (median, 21 days vs. 28 days). Treatment with lopinavir-ritonavir (adjusted hazard ratio [aHR], 2.28; 95% confidence interval [CI], 1.24 to 4.21) and younger age (aHR, 2.64; 95% CI 1.43 to 4.87) was associated with negative conversion of viral RNA. There was no significant difference in time to clinical improvement between lopinavir-ritonavir- and hydroxychloroquine-treated patients (median, 18 days vs. 21 days). Lymphopenia and hyperbilirubinemia were more frequent in lopinavir-ritonavir-treated patients compared with hydroxychloroquine-treated patients.</AbstractText><AbstractText Label="CONCLUSION">Lopinavir-ritonavir was associated with more rapid viral clearance than hydroxychloroquine in mild to moderate COVID-19, despite comparable clinical responses. These findings should be confirmed in randomized, controlled trials.</AbstractText></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Kim</LastName><ForeName>Ji-Won</ForeName><Initials>JW</Initials><AffiliationInfo><Affiliation>Divisions of Rheumatology, Department of Internal Medicine, Daegu Catholic University School of Medicine, Daegu, Korea.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Kim</LastName><ForeName>Eun Jin</ForeName><Initials>EJ</Initials><AffiliationInfo><Affiliation>Divisions of Pulmonology, Department of Internal Medicine, Daegu Catholic University School of Medicine, Daegu, Korea.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Kwon</LastName><ForeName>Hyun Hee</ForeName><Initials>HH</Initials><AffiliationInfo><Affiliation>Divisions of Infectious Diseases, Department of Internal Medicine, Daegu Catholic University School of Medicine, Daegu, Korea.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Jung</LastName><ForeName>Chi Young</ForeName><Initials>CY</Initials><AffiliationInfo><Affiliation>Divisions of Pulmonology, Department of Internal Medicine, Daegu Catholic University School of Medicine, Daegu, Korea.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Kim</LastName><ForeName>Kyung Chan</ForeName><Initials>KC</Initials><AffiliationInfo><Affiliation>Divisions of Pulmonology, Department of Internal Medicine, Daegu Catholic University School of Medicine, Daegu, Korea.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Choe</LastName><ForeName>Jung-Yoon</ForeName><Initials>JY</Initials><AffiliationInfo><Affiliation>Divisions of Rheumatology, Department of Internal Medicine, Daegu Catholic University School of Medicine, Daegu, Korea.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Hong</LastName><ForeName>Hyo-Lim</ForeName><Initials>HL</Initials><AffiliationInfo><Affiliation>Divisions of Infectious Diseases, Department of Internal Medicine, Daegu Catholic University School of Medicine, Daegu, Korea.</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><GrantList CompleteYN="Y"><Grant><Agency>Research Institute of Medical Science, Catholic University of Daegu</Agency><Country></Country></Grant><Grant><Agency>Daegu Medical Association COVID-19 scientific committee</Agency><Country></Country></Grant></GrantList><PublicationTypeList><PublicationType UI="D003160">Comparative Study</PublicationType><PublicationType UI="D016428">Journal Article</PublicationType><PublicationType UI="D013485">Research Support, Non-U.S. Gov't</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2020</Year><Month>06</Month><Day>16</Day></ArticleDate></Article><MedlineJournalInfo><Country>Korea (South)</Country><MedlineTA>Korean J Intern Med</MedlineTA><NlmUniqueID>8712418</NlmUniqueID><ISSNLinking>1226-3303</ISSNLinking></MedlineJournalInfo><ChemicalList><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D000998">Antiviral Agents</NameOfSubstance></Chemical><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D004338">Drug Combinations</NameOfSubstance></Chemical><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="C558899">lopinavir-ritonavir drug combination</NameOfSubstance></Chemical><Chemical><RegistryNumber>2494G1JF75</RegistryNumber><NameOfSubstance UI="D061466">Lopinavir</NameOfSubstance></Chemical><Chemical><RegistryNumber>4QWG6N8QKH</RegistryNumber><NameOfSubstance UI="D006886">Hydroxychloroquine</NameOfSubstance></Chemical><Chemical><RegistryNumber>O3J8G9O825</RegistryNumber><NameOfSubstance UI="D019438">Ritonavir</NameOfSubstance></Chemical></ChemicalList><SupplMeshList><SupplMeshName Type="Protocol" UI="C000705127">COVID-19 drug treatment</SupplMeshName></SupplMeshList><CitationSubset>IM</CitationSubset><MeshHeadingList><MeshHeading><DescriptorName UI="D000368" MajorTopicYN="N">Aged</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000369" MajorTopicYN="N">Aged, 80 and over</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000998" MajorTopicYN="N">Antiviral Agents</DescriptorName><QualifierName UI="Q000009" MajorTopicYN="N">adverse effects</QualifierName><QualifierName UI="Q000627" MajorTopicYN="Y">therapeutic use</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D000086382" MajorTopicYN="N">COVID-19</DescriptorName><QualifierName UI="Q000175" MajorTopicYN="N">diagnosis</QualifierName><QualifierName UI="Q000188" MajorTopicYN="Y">drug therapy</QualifierName><QualifierName UI="Q000821" MajorTopicYN="N">virology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D004338" MajorTopicYN="N">Drug Combinations</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D005260" MajorTopicYN="N">Female</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006886" MajorTopicYN="N">Hydroxychloroquine</DescriptorName><QualifierName UI="Q000009" MajorTopicYN="N">adverse effects</QualifierName><QualifierName UI="Q000627" MajorTopicYN="Y">therapeutic use</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D061466" MajorTopicYN="N">Lopinavir</DescriptorName><QualifierName UI="Q000009" MajorTopicYN="N">adverse effects</QualifierName><QualifierName UI="Q000627" MajorTopicYN="Y">therapeutic use</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D008297" MajorTopicYN="N">Male</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D008875" MajorTopicYN="N">Middle Aged</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D012189" MajorTopicYN="N">Retrospective Studies</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D019438" MajorTopicYN="N">Ritonavir</DescriptorName><QualifierName UI="Q000009" MajorTopicYN="N">adverse effects</QualifierName><QualifierName UI="Q000627" MajorTopicYN="Y">therapeutic use</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D000086402" MajorTopicYN="N">SARS-CoV-2</DescriptorName><QualifierName UI="Q000187" MajorTopicYN="Y">drug effects</QualifierName><QualifierName UI="Q000472" MajorTopicYN="N">pathogenicity</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D013997" MajorTopicYN="N">Time Factors</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D016896" MajorTopicYN="N">Treatment Outcome</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D019562" MajorTopicYN="N">Viral Load</DescriptorName></MeshHeading></MeshHeadingList><KeywordList Owner="NOTNLM"><Keyword MajorTopicYN="Y">COVID-19</Keyword><Keyword MajorTopicYN="Y">Hydroxychloroquine</Keyword><Keyword 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