{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,24]],"date-time":"2026-03-24T08:44:45Z","timestamp":1774341885638,"version":"3.50.1"},"reference-count":34,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,3,21]],"date-time":"2026-03-21T00:00:00Z","timestamp":1774051200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Carlos Chagas Filho Rio de Janeiro State Science Foundation","award":["E-26\/211.126\/202"],"award-info":[{"award-number":["E-26\/211.126\/202"]}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100021671","name":"Brazilian National Cancer Institute","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100021671","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Viruses"],"abstract":"<jats:p>Based on the follow-up of patients who recovered from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, several reports of people who re-tested positive have been described. This may result from viral reactivation, true reinfection, superinfection, or an initial infection by more than one virus (multiple infection). These scenarios can only be correctly distinguished through viral quasispecies analysis. Herein, 26 cancer patients under extended follow-up for SARS-CoV-2 infection were submitted to multiple longitudinal analyses through nucleic acid isolation, PCR amplification and high-throughput sequencing. SARS-CoV-2 classification and the definition of cases as persistent or repeated infections were based on phylogenetic reconstruction. Supported by their viral complete genomes and intrahost quasispecies over time, the different scenarios were identified. Nine confirmed and 12 plausible persistence cases were identified. Virus evolution dynamics in the intrahost population from patients with persistent infection was shown for the first time. Regarding reinfection, three confirmed and two plausible cases were identified, including one case of multiple infection. Altogether, this is the first study that analyzes the plethora of SARS-CoV-2 within-host minor variants and describes reinfections, multiple infections and viral evolution across time in cancer patients, contributing to the understanding of SARS-CoV-2\u2019s within-host population dynamics in the natural history of COVID-19.<\/jats:p>","DOI":"10.3390\/v18030393","type":"journal-article","created":{"date-parts":[[2026,3,23]],"date-time":"2026-03-23T13:07:06Z","timestamp":1774271226000},"page":"393","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Disentangling SARS-CoV-2 Sustained Viremia Cases: Evolution, Persistence and Reinfection"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6230-3109","authenticated-orcid":false,"given":"Brunna M.","family":"Alves","sequence":"first","affiliation":[{"name":"Programa de Gen\u00e9tica e Virologia Tumoral, Instituto Nacional de C\u00e2ncer, Rio de Janeiro 20231-050, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Filipe R. R.","family":"Moreira","sequence":"additional","affiliation":[{"name":"Departamento de Gen\u00e9tica, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-901, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marianne M.","family":"Garrido","sequence":"additional","affiliation":[{"name":"Comit\u00ea de Controle de Infec\u00e7\u00e3o Hospitalar, Instituto Nacional de C\u00e2ncer, Rio de Janeiro 20230-130, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pedro S. de","family":"Carvalho","sequence":"additional","affiliation":[{"name":"Programa de Gen\u00e9tica e Virologia Tumoral, Instituto Nacional de C\u00e2ncer, Rio de Janeiro 20231-050, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-1086-9652","authenticated-orcid":false,"given":"\u00c9lida M. de","family":"Oliveira","sequence":"additional","affiliation":[{"name":"Programa de Gen\u00e9tica e Virologia Tumoral, Instituto Nacional de C\u00e2ncer, Rio de Janeiro 20231-050, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-9337-7956","authenticated-orcid":false,"given":"Caroline C. de","family":"S\u00e1","sequence":"additional","affiliation":[{"name":"Programa de Gen\u00e9tica e Virologia Tumoral, Instituto Nacional de C\u00e2ncer, Rio de Janeiro 20231-050, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James","family":"Arthos","sequence":"additional","affiliation":[{"name":"Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, Bethesda, MD 20892, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Claudia","family":"Cicala","sequence":"additional","affiliation":[{"name":"Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, Bethesda, MD 20892, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0698-3146","authenticated-orcid":false,"given":"Jo\u00e3o P. B.","family":"Viola","sequence":"additional","affiliation":[{"name":"Programa de Imunologia e Biologia Tumoral, Instituto Nacional de C\u00e2ncer, Rio de Janeiro 20231-050, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4909-4912","authenticated-orcid":false,"given":"Livia R.","family":"Goes","sequence":"additional","affiliation":[{"name":"Programa de Gen\u00e9tica e Virologia Tumoral, Instituto Nacional de C\u00e2ncer, Rio de Janeiro 20231-050, Brazil"},{"name":"Departamento de Gen\u00e9tica e Biologia Molecular, Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro 20211-010, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4266-9795","authenticated-orcid":false,"given":"Juliana D.","family":"Siqueira","sequence":"additional","affiliation":[{"name":"Programa de Gen\u00e9tica e Virologia Tumoral, Instituto Nacional de C\u00e2ncer, Rio de Janeiro 20231-050, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9013-2570","authenticated-orcid":false,"given":"Marcelo A.","family":"Soares","sequence":"additional","affiliation":[{"name":"Programa de Gen\u00e9tica e Virologia Tumoral, Instituto Nacional de C\u00e2ncer, Rio de Janeiro 20231-050, Brazil"},{"name":"Departamento de Gen\u00e9tica, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-901, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1199","DOI":"10.1056\/NEJMoa2001316","article-title":"Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus\u2013Infected Pneumonia","volume":"382","author":"Li","year":"2020","journal-title":"N. 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