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A combination antiviral therapeutic regimen being evaluated by the National Taiwan University Hospital for the treatment of persistent SARS-CoV-2 infection in immunocompromised patients. The regimen consists of an extended 5-day intravenous infusion of remdesivir combined with a 10-day oral course of nirmatrelvir/ritonavir (Paxlovid). Remdesivir is a nucleotide analog that inhibits the viral RNA-dependent RNA polymerase (RdRp), while nirmatrelvir is a peptidomimetic inhibitor of the SARS-CoV-2 main protease (3CLpro). Ritonavir is co-administered as a pharmacokinetic enhancer that inhibits the cytochrome P450 3A4 (CYP3A4) enzyme, thereby increasing the plasma concentration and half-life of nirmatrelvir. This triple-combination approach is specifically designed to achieve viral clearance in patients who experience prolonged viral shedding and fail to respond to standard short-course antiviral therapies.
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