Hydroxychloroquine causes viral load reduction in Covid-19 patients | Hacker News Reader

Hydroxychloroquine causes viral load reduction in Covid-19 patients

covidtrial.io

104 pointsronreiter42 comments

~sigh~ just got this note from my mother, who has taken hydroxychloroquine ever since she was diagnosed with lupus over 30 years ago:

> just spent a nightmaremorning trying to get my Lupus meds. [after this hydroxychloroquine/covid-19 announcement], no pharmacy has any!

> I spoke directly to the pharmacist. she said that she has no control. this wil be first come first serve, she cannot give preferential treatment even though I have been diagnosed for 33 years and buying this med from her for a long time.

> she has reordered. shes gets many requests an hour today for MY lupus medication. im on a list

Is it not a prescription-only medication (as it is in Australia)? That might be a potential solution to her predicament.

Just one tragedy-of-the-commons after another.

The immunology department of Marseille, France reported 3 days ago that taking hydroxy-chloroquine and azithromycin together led to 90% of pilot program patients testing negative after 6 days.

There are also several publications under review at the NIH. Glad to see the US Gov. stepping up to the plate so fast on the subject.

https://en.wikipedia.org/wiki/Hydroxychloroquine#Research

...

> Hydroxychloroquine and chloroquine have been recommended by Chinese and South Korean health authorities for the treatment COVID-19.[31] [32] In vitro studies have demonstrated that hydroxychloroquine is more potent than chloroquine against SARS-CoV-2 with a more tolerable safety profile.[33]

> On 16 March 2020, advisor to the French Government on COVID-19, Professor Didier Raoult, announced that a non-randomized unblinded trial[34] involving 24 patients from the south east of France supported the claim that hydroxychloroquine was an effective treatment for COVID-19.[35] The trial is yet to be peer-reviewed.[34] An amount of 600 mg of hydroxychloroquine (brand name Plaquenil) was administered to these patients every day for 10 days. They reported "a significant decrease in viral load".[34] The drug appeared to be responsible for a "rapid and effective speeding up of their healing process, and a sharp decrease in the amount of time they remained contagious".[36] 70% of patients were "considered cured", compared with 12.5% of those who did not receive hydroxychloroquine and azithromycin combination.[34] The antibiotic azithromycin - which is known to be effective against secondary infections from bacterial lung disease - led to even better outcomes. Professor Raoult said the results showed there was "a spectacular reduction in the number of positive cases" with the combination therapy. At 6 days, among patients given combination therapy, the percentage of cases still carrying SARS-CoV-2 was no more than 5%.[37][38]

> On March 17 after testing in several hospitals around Italy the Italian Pharmaceutical Agency has included hydroxychloroquine in the list of drugs with positive preliminary results for treatment of coronavirus disease 2019.[39]

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What is strange is that azithromycin - leads to better outcomes. It is used for bacterial infections but Covid is a virus. How can this be?

I would guess that opportunistic bacterial co-infections are being suppressed by the azithromycin, which leaves more room for the immune system to respond directly to SARS-CoV-2. Viral Pneuomonia can easily lead to Bacterial Pneumonia. Combined with an attack directly on SARS-CoV-2, and you get a combination therapy that hopefully works.

While your explanation seems the most likely, macrolide compounds like Azithromycin may actually have direct antiviral effects of their own: https://erj.ersjournals.com/content/45/2/428

Thank you for that! I had no idea Azithromycin had those effects.

That's against rhinovirus, not coronavirus.

The study focused on rhinoviruses because they are the dominant source of viral morbidity in CF patients. If their proposed MoA (interferon agonist in epithelial cells) is correct, there’s a good reason to believe the antiviral effect is nonspecific to rhinovirus.

I thought the same things when I saww these type of effect in antibiotics, but lots of antibiotics have lots of off target effects. Minocycline for instance might be helpful with depression and MS.

And it's usually not through the bacterial co-infections route unless you find the same effect with all broad spectrum anti-biotics.

I recall vividly an article about the importance of physical fitness and in particular stability exercises in old age. The author proposed that a lot of people die from a broken hip, but you don’t see it in the death statistics because the proximal cause of death is pneumonia brought on by confinement to bed after the injury. The domino you have some control over is not falling and hurting yourself so badly in the first place.

The flu doesn’t last as long, but it brings fluid to the lungs. Protecting from infection is huge.

To any scientists - an anti-malarial is found to be effective against coronavirus. At the same time, initial reports are suggesting that people with type O blood have a reduced risk of infection and lower infection severity than those with other blood types. The same pattern also holds true for malaria, with type O blood having a protective and suppressive effect. If the coronavirus is getting into cells via the ACE2 receptor, why would we expect any of this other stuff to be effective? Why is an anti-parasitic working to reduce viral load? Why is the same blood type protective of both? What common mechanism of action or attack (perhaps hitching a ride on blood cells to spread through the body?) are we missing?

I am not a scientist, but I have been following the scientists that are studying this. Chloroquine is a zinc ionophore much like the supplement Quercetin [1][2][3]. Both allow zinc to be transported into the cell, preventing or slowing the RNA transcoding process that hijacks your replicator functions. This vastly slows down the replication, allowing your adaptive immune system to get ahead of and destroy the virus faster than it can replicate.

I am not familiar with the observations around type-O blood, but I have been following the discussions on ACE2 and ACE/ACE2 inhibitors (blood pressure meds) which is interesting. The jury is still out on that one, but the theory for ARB's is forcing a binding that blocks nCoV from attaching to the receptor. [4]

[1] - https://examine.com/supplements/quercetin/

[2] - https://www.ncbi.nlm.nih.gov/pubmed/25050823

[3] - https://www.youtube.com/watch?v=vE4_LsftNKM Chloroquin, Quecertin 6 mins in

[4] - https://www.youtube.com/watch?v=1vZDVbqRhyM

Given that Chroloquine has been around for a long time and that it is well studied, is there any merit to assume that using it was not a random idea and that it works against some other known RNA viruses?

It is know to be a zinc ionophore so I would not call it random. That said, it is known to have some side effects. [1] My concern around its use is that it requires a prescription. People won't likely be using this until a doctor prescribes it. By the time a person has gone to a doctor, the virus has likely already replicated quite extensively. Zinc ionophores would be most beneficial if taken very early on after initial infection.

[1] - https://medlineplus.gov/druginfo/meds/a682318.html

Apparently the possible utility of chloroquine was discovered because SLE patients on it in China weren't getting Covid-19 during the outbreak [0].

[0]: https://www.jqknews.com/news/388543-The_novel_coronavirus_pn...

Chloroquine was discovered effective against SARS-coronavirus following the 2003 outbreak.

Based on your research, would you suggest taking Quercetin daily as a supplement?

I don't suggest taking anything to anyone. You should research a supplement and compare its benefits and risks based on your physiology. There probably isn't a one size fits all answer with most phytochemicals. I personally use it to boost the effect of TransResveratrol.

I'm not near being a scientist, but the wikipedia page for Resveratrol (https://en.wikipedia.org/wiki/Resveratrol) lists no health effects, what effects are you taking that for?

It's weird, right? I spent some time last night trying to figure out exactly what the mechanism is that chloroquine has when it works. It looks like there may be more than one mechanism in place.

In the malaria parasite, it kills the parasite by hitting up the lysosome (or something intracellular at least - interaction with a protein, can't remember details).

In humans, things get a little bit more fuzzy. It accumulates in lysosomes, and then how it stops Coronaviruses or is effective in lupus treatment isn't very clear. I've seen arguments that it changes pH, or the caspases can't work any more, but that doesn't explain very much.

My bet is that it's screwing with the organisation of the secretory system, which means that virus can't get out properly (maybe budding is broken).

The ABO blood system link is something else altogether, but probably hints towards other functions of blood type in regulating something other than self/other recognition (although virus itself may carry ABO epitope).

> At the same time, initial reports are suggesting that people with type O blood have a reduced risk of infection and lower infection severity than those with other blood types.

[citation appreciated]

https://www.medrxiv.org/content/10.1101/2020.03.11.20031096v...

Type A: 1.20:1 Type O: 0.67:1

Watch this episode of medcram where he explains it: https://www.youtube.com/watch?v=U7F1cnWup9M

Also the most recent french study is here: https://drive.google.com/file/d/186Bel9RqfsmEx55FDum4xY_IlWS...

The report is from a small trial that was not blind or randomized. Encouraging, but hardly worthy of the headline. How about "Hydroxychloroquine associated with viral load reduction in a small number of Covid-19 patients"?

Study from Marseille seems well founded, although (of course) based on a small sample. Why isn't this higher up?

Thankfully it seems like US and French governments have seen the study and immediately decided to remove red tape for larger sample sizes.

https://med.umn.edu/news-events/covid-19-clinical-trial-laun...

I just hope they don't wait "weeks" if they see in 10 days significant results. They can wait weeks for the formal, 100 page study, but hope we see some tweets saying go/no go in 10 days after rolling this out.

Don’t worry. The people who matter are on it. Chloroquine and Hydroxychloroquine in particular have been the leading therapeutic interventions in the clinical research publications for... quite some time (honestly every week feels like a month so I am losing track).

Trump also said yesterday I believe he ordered FDA to fast track both versions plus another antiviral remdesivir that is also showing effects.

I hope this makes it on the front page. This might be a real solution to a large portion of the problem given that it is readily available, easy to manufacture, and prevents infection with less side effects than regular chloroquine. Large amounts of the population could be prescribed this as a prophylactic and prevent much of the spread from occurring even in high risk occupations. I would love to see the telehealth system used to send prescriptions for this to pharmacies everywhere for at risk workers.

Trump already gave a press conference about it today about the FDA investigating it quickly

This is exactly the kind of response we need. A well known, well understood medicine with a low risk profile that we can deploy as soon as possible.

If the CDC believes that destroying the economy to stop this disease is worth it, then I can't doubt that the FDA would agree that deploying this medication immediately is worth the risk.

Due to the outbreak global supplies will be disrupted also there are people that take it as prescription medicine for arthritis, its relevant people to have access to the synthesis of it. Here is a paper describing cost effective way to synthesis it [1].Its not trivial task but good information to have access to. Had a quick look at the precursor chemicals used in this synthesis they are sold from global chemical suppliers and doesn't seem to have any specific restriction for sell.

[1] https://www.beilstein-journals.org/bjoc/articles/14/45

Anyone care to explain the risks of using this drug?

- I know one must get tested for G6PD deficiency or it may lead to a hemolytic crisis. But I'm unsure how probable one is to have it or how long until this potential problem arises.

- I heard this drug can cause heart attacks in some people, Can this be predicted by a test? Some users on r/covid19 were advising against taking it without doctor supervision in a hospital for this reason but didn't explain nor gave statistics, as usual. The problem was related to prolonged qt intervals

For one, hydroxychloroquine, and especially when used in combination with azithromycin, can cause prolongation of an electrocardiogram interval called QT. The degree of QT prolongation is associated with a risk of sudden cardiac death. QT prolongation is an issue in patients with underlying heart disease or electrolyte abnormalities. QT > 500 is associated w/ increased risk of sudden death.

For those who are infected with Covid-19, but observe low severity in symptoms, is there a correlation to how they'll fare through the disease?

I.e., perhaps they need not even take this medication?

This is the first promising bit of news I've seen in days.

This looks like a vaccine to me.

We sometimes use weakened live viruses as vaccines. For example, we did it for polio.

Hydroxychloroquine weakens the virus. No, it isn't genetically weakened, but that doesn't make a difference. Start the person on hydroxychloroquine, then give them the virus.

Why are herbs never included in any clinical trials. Are they totally worthless although used extensively

I don't think you're on the right website.

There are several reasons, but a big one is that they cannot be mass produced with consistent quality as easily as synthesized chemicals.

The Chinese treatment guides include evidence-based traditional Chinese medicine that has shown impact on this disease.

https://www.reddit.com/r/COVID19/comments/fjj8yb/chinese_gui...

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