{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T23:23:45Z","timestamp":1778801025219,"version":"3.51.4"},"reference-count":30,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2023,9,26]],"date-time":"2023-09-26T00:00:00Z","timestamp":1695686400000},"content-version":"vor","delay-in-days":25,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","award":["174925"],"award-info":[{"award-number":["174925"]}],"id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","award":["177701"],"award-info":[{"award-number":["177701"]}],"id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003579","name":"University of Toronto","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100003579","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100002977","name":"Dalhousie University","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100002977","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000038","name":"Natural Sciences and Engineering Research Council of Canada","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000038","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000155","name":"Social Sciences and Humanities Research Council of Canada","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000155","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Influenza Resp Viruses"],"published-print":{"date-parts":[[2023,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Remdesivir (RDV) has been shown to reduce hospitalization and mortality in COVID\u201019 patients. Resistance mutations caused by RDV are rare and have been predominantly reported in patients who are on prolonged therapy and immunocompromised. We investigate the effects of RDV treatment on intra\u2010host SARS\u2010CoV\u20102 diversity and low\u2010frequency mutations in moderately ill hospitalized COVID\u201019 patients and compare them to patients without RDV treatment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>From March 2020 to April 2022, sequential collections of nasopharyngeal and mid\u2010turbinate swabs were obtained from 14 patients with and 30 patients without RDV treatment. Demographic and clinical data on all patients were reviewed. A total of 109 samples were sequenced and mutation analyses were performed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Previously reported drug resistant mutations in nsp12 were not identified during short courses of RDV therapy. In genes encoding and surrounding the replication complex (nsp6\u2010nsp14), low\u2010frequency minority variants were detected in 7\/14 (50%) and 18\/30 (60%) patients with and without RDV treatment, respectively. We did not detect significant differences in within\u2010host diversity and positive selection between the RDV\u2010treated and untreated groups.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Minimal intra\u2010host variability and stochastic low\u2010frequency variants detected in moderately ill patients suggests little selective pressure in patients receiving short courses of RDV. The barrier to RDV resistance is high in patients with moderate disease. Patients undergoing short regimens of RDV therapy should continue to be monitored.<\/jats:p><\/jats:sec>","DOI":"10.1111\/irv.13179","type":"journal-article","created":{"date-parts":[[2023,9,27]],"date-time":"2023-09-27T01:37:12Z","timestamp":1695778632000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Use of whole genome sequencing to identify low\u2010frequency mutations in SARS\u2010CoV\u20102 patients treated with remdesivir"],"prefix":"10.1111","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8226-7969","authenticated-orcid":false,"given":"Kuganya","family":"Nirmalarajah","sequence":"first","affiliation":[{"name":"Sunnybrook Research Institute  Toronto Ontario Canada"},{"name":"Department of Laboratory Medicine and Pathobiology University of Toronto  Toronto Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Winfield","family":"Yim","sequence":"additional","affiliation":[{"name":"Sunnybrook Research Institute  Toronto Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patryk","family":"Aftanas","sequence":"additional","affiliation":[{"name":"Shared Hospital Laboratory  Toronto Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Angel X.","family":"Li","sequence":"additional","affiliation":[{"name":"Sinai Health System  Toronto Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Altynay","family":"Shigayeva","sequence":"additional","affiliation":[{"name":"Sinai Health System  Toronto Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7387-0387","authenticated-orcid":false,"given":"Lily","family":"Yip","sequence":"additional","affiliation":[{"name":"Sunnybrook Research Institute  Toronto Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zoe","family":"Zhong","sequence":"additional","affiliation":[{"name":"Sinai Health System  Toronto Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5647-6137","authenticated-orcid":false,"given":"Allison J.","family":"McGeer","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine and Pathobiology University of Toronto  Toronto Ontario Canada"},{"name":"Sinai Health System  Toronto Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Finlay","family":"Maguire","sequence":"additional","affiliation":[{"name":"Faculty of Computer Science Dalhousie University  Halifax Nova Scotia Canada"},{"name":"Department of Community Health &amp; 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