Clinical outcomes of patients with coronavirus disease 2019 and active tuberculosis co-infection in Beijing China: A retrospective single-center descriptive study
et al., Infectious Medicine, doi:10.1016/j.imj.2025.100169, Feb 2025
Retrospective 102 COVID-19 patients with active tuberculosis co-infection showing a mortality rate of 9.8%, compared with 0.03% for patients with COVID-19 alone. Paxlovid was used for 19 patients due limited availability but resulted in higher mortality in unadjusted results.
Resistance. Variants may be resistant to paxlovid1-8. Use may promote the emergence of variants that weaken host immunity and potentially contribute to long COVID9. Confounding by contraindication. Hoertel et al. find that over 50% of patients that died had a contraindication for the use of Paxlovid10. Retrospective studies that do not exclude contraindicated patients may significantly overestimate efficacy. Black box warning. The FDA notes that severe, life-threatening, and/or fatal adverse reactions due to drug interactions have been reported in patients treated with paxlovid11. Kidney and liver injury. Studies show significantly increased risk of acute kidney injury12 and liver injury13.
Standard of Care (SOC) for COVID-19 in the study country,
China, is average with moderate efficacy for approved treatments14.
This study is excluded in the after exclusion results of meta
analysis:
unadjusted results with no group details; substantial unadjusted confounding by indication possible.
|
risk of death, 336.8% higher, RR 4.37, p = 0.02, treatment 5 of 19 (26.3%), control 5 of 83 (6.0%).
|
| Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates |
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Lopez et al., SARS-CoV-2 Resistance to Small Molecule Inhibitors, Current Clinical Microbiology Reports, doi:10.1007/s40588-024-00229-6.
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Zvornicanin et al., Molecular Mechanisms of Drug Resistance and Compensation in SARS-CoV-2 Main Protease: The Interplay Between E166 and L50, bioRxiv, doi:10.1101/2025.01.24.634813.
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Vukovikj et al., Impact of SARS-CoV-2 variant mutations on susceptibility to monoclonal antibodies and antiviral drugs: a non-systematic review, April 2022 to October 2024, Eurosurveillance, doi:10.2807/1560-7917.ES.2025.30.10.2400252.
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8.
Zhou (B) et al., SARS-CoV-2 Mpro inhibitor ensitrelvir: asymmetrical cross-resistance with nirmatrelvir and emerging resistance hotspots, Emerging Microbes & Infections, doi:10.1080/22221751.2025.2552716.
9.
Thomas et al., Nirmatrelvir-Resistant Mutations in SARS-CoV-2 Mpro Enhance Host Immune Evasion via Cleavage of NF-κB Essential Modulator, bioRxiv, doi:10.1101/2024.10.18.619137.
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Hoertel et al., Prevalence of Contraindications to Nirmatrelvir-Ritonavir Among Hospitalized Patients With COVID-19 at Risk for Progression to Severe Disease, JAMA Network Open, doi:10.1001/jamanetworkopen.2022.42140.
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FDA, Fact sheet for healthcare providers: emergency use authorization for paxlovid, www.fda.gov/media/155050/download.
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Kamo et al., Association of Antiviral Drugs for the Treatment of COVID-19 With Acute Renal Failure, In Vivo, doi:10.21873/invivo.13637.
Yang et al., 18 Feb 2025, retrospective, China, peer-reviewed, mean age 54.5, 21 authors, study period 1 December, 2022 - 18 January, 2023.
Contact: yl-14t@163.com, laurence.luu@uts.edu.au, panjunhua999@sina.com, wildwolf0101@163.com, wangguirong1230@ccmu.edu.cn.
Clinical outcomes of patients with coronavirus disease 2019 and active tuberculosis co-infection in Beijing China: A retrospective single-center descriptive study
Infectious Medicine, doi:10.1016/j.imj.2025.100169
Background: Coronavirus disease 2019 (COVID-19) and tuberculosis (TB) co-infection (COVID-19-TB) has the potential to exacerbate lung damage; however, information about the clinical features of COVID-19-TB is limited. This study aims to clarify the clinical characteristics and outcomes of patients with COVID-19-TB. Methods: In this single-center retrospective study, the clinical features and outcomes of patients with COVID-19 with active TB who were admitted to Beijing Chest Hospital, Beijing, China, from 1 December 2022 to 18 January 2023 were collected. The severity of COVID-19 and TB was graded according to guidelines from the World Health Organization. The relationships of demographic and clinical variables with intensive care unit (ICU) admission were evaluated using univariable and multivariable logistic regression models. Results: Overall, 102 patients with COVID-19-TB were enrolled. The mean age was 54.5 years (range 36.5-70 years). The most common clinical manifestations were cough (68.63%), sputum production (53.92%), fever (51.96%), and ground-glass opacities (35.29%). Complications included acute respiratory distress syndrome (11.76%), sepsis (9.8%), and respiratory failure (7.84%). Patients with COVID-19-TB had high concentrations of various proinflammatory cytokines, including interferon-𝛾, interleukin-1 𝛽, interferon-𝛾-inducible protein 10 kD, and monocyte chemoattractant protein-1. Sixteen of the 102 patients with COVID-19-TB (15.69%) were admitted to the ICU, and 10 (9.80%) died during hospitalization. The significant risk factors for ICU admission were respiratory failure, pulmonary fungal infection, and ventilation and oxygen therapy. Conclusions: The mortality rate of COVID-19-TB was 9.80%. Several demographic and clinical characteristics were associated with adverse outcomes, indicating the importance of early recognition and treatment.
Declaration of competing interest The authors declare no conflict of interest.
Supplementary materials Supplementary material associated with this article can be found in the online version at doi:10.1016/j.imj. 2025.100169 .
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