Lopinavir/ritonavir and interferon combination therapy may help shorten the duration of viral shedding in patients with COVID-19: A retrospective study in two designated hospitals in Anhui, China

J Med Virol. 2020 Nov;92(11):2666-2674. doi: 10.1002/jmv.26127. Epub 2020 Jun 29.


Prolonged viral shedding may pose a threat to the control of coronavirus disease-2019 (COVID-19), and data on the duration of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) shedding are still limited, with the associated factors being unknown. All adult patients with laboratory-confirmed COVID-19 were included in this retrospective cross-sectional study in two designated hospitals during 21 January 2020 to 16 March 2020 in Anhui, China. In all patients, data on the duration of SARS-CoV-2 RNA shedding were analyzed by reviewing all RNA detection results during hospitalization. In addition, demographic, clinical, treatment, laboratory, and outcome data were also collected from electronic medical records. Factors associated with prolonged viral shedding were analyzed with the Cox proportional hazards model. Among 181 patients, the mean age was 44.3 ± 13.2 years, and 55.2% were male. The median duration of viral shedding from illness onset was 18.0 days (interquartile range [IQR], 15.0-24.0). Prolonged viral shedding was associated with longer hospital stays (P < .001) and higher medical costs (P < .001). The severity of COVID-19 had nothing to do with prolonged shedding. Moreover, the median time from onset to antiviral treatment initiation was 5.0 days (IQR, 3.0-7.0). Delayed antiviral treatment (hazard ratio [HR], 0.976; 95% confidence interval [CI], 0.962-0.990]) and lopinavir/ritonavir + interferon-α (IFN-α) combination therapy as the initial antiviral treatment (HR 1.649; 95% CI, 1.162-2.339) were independent factors associated with prolonged SARS-CoV-2 RNA shedding. SARS-CoV-2 showed prolonged viral shedding, causing increased hospital stays and medical costs. Early initiation of lopinavir/ritonavir + IFN-α combination therapy may help shorten the duration of SARS-CoV-2 shedding.

Keywords: COVID-19; associated factors; outcomes; treatment; viral shedding.

Publication types

  • Multicenter Study

MeSH terms

  • Adult
  • Antiviral Agents / therapeutic use*
  • COVID-19 / drug therapy*
  • China
  • Cross-Sectional Studies
  • Drug Combinations
  • Drug Therapy, Combination
  • Female
  • Hospitalization / statistics & numerical data
  • Humans
  • Interferons / therapeutic use*
  • Lopinavir / therapeutic use*
  • Male
  • Middle Aged
  • RNA, Viral / analysis
  • Retrospective Studies
  • Ritonavir / therapeutic use*
  • Time Factors
  • Virus Shedding / drug effects*


  • Antiviral Agents
  • Drug Combinations
  • RNA, Viral
  • lopinavir-ritonavir drug combination
  • Lopinavir
  • Interferons
  • Ritonavir