Reducing Adenoviral Patient Infected Days (RAPID) Study: Correlation of adenoviral load with severity of adenoviral conjunctivitis and viral clearance over 21 days

Abstract

Purpose : To investigate the correlation of viral load at baseline and over 21 days with severity of signs, symptoms, and viral clearance in participants with adenoviral conjunctivitis.

Methods : Of 212 participants screened for adenoviral conjunctivitis (Ad-Cs), 56 met the following criteria and were randomized: ≥ 18 years of age, symptoms ≤ 4 days, a positive point-of-care immunoassay via AdenoPlus^TM (Quidel, San Diego CA). One eye of each participant was randomized to a single, in-office administration of either 5% povidone-iodine (PVP-I) or artificial tears (AT). Examinations at baseline, days 1-2, 4, 7, 14, and 21 included assessment of participant symptoms, clinician graded signs, and conjunctival swabs for qPCR analysis. Repeated measures generalized estimating equations were used for calculating the correlation (r) of viral load with signs and symptoms over 21 days. Severity of signs and symptoms is reported for 3 equal size tertiles of baseline viral load: low (log qPCR <6.13), middle (log qPCR 6.13-6.78) and high (log qPCR >6.78).

Results : Twenty-five participants were qPCR positive for adenovirus and had sufficient follow-up visits. Viral load was not correlated with participant symptoms or clinician graded signs at baseline. However, higher viral load over 21 days had correlations with increased severity of participant symptoms of tearing, matting and redness (r≥0.70; p<0.02) and with clinician graded signs of bulbar redness and serous discharge (r≥0.60; p<0.01). Higher baseline titers were correlated with longer time to viral clearance (r=0.59, p=0.0075). Days to viral clearance in low, middle and high baseline viral titer tertiles were 10.3 + 5.6, 9.5 + 3.5, and 19.8 + 3.8, respectively. The incidence of subepithelial infiltrates or pseudomembranes was higher in the highest tertile of viral load (75%, 6 of 8) compared to the lowest tertile (40%, 4 of 10, p=0.43).

Conclusions : High correlations were found between viral load with more severe signs and symptoms over 21 days. Higher baseline viral load was associated with longer time to viral clearance.

This is a 2021 ARVO Annual Meeting abstract.