Immunocompromised Patients with Protracted COVID-19: a Review of “Long Persisters”

Abstract

Purpose of Review Certain immunocompromised individuals are at risk for protracted COVID-19, in which SARS-CoV-2 leads to a chronic viral infection. However, the pathogenesis, diagnosis, and management of this phenomenon remain ill-defined. Recent Findings Herein, we review key aspects of protracted SARS-CoV-2 infection in immunocompromised individuals, or the so-called long persisters, and describe the clinical presentation, risk factors, diagnosis, and treatment modalities of this condition, as well as intra-host viral evolution. Based on the available data, we also propose a framework of criteria with which to approach this syndrome. Summary Protracted COVID-19 is an uncharacterized syndrome affecting patients with B-cell depletion; our proposed diagnostic approach and definitions will inform much needed future research.

Successful Treatment of Prolonged Severe Acute Respiratory Syndrome Coronavirus 2 Infection in Patients With Immunodeficiency With Extended Nirmatrelvir/Ritonavir: Case Series

“…Short courses of antivirals, including nirmatrelvir/ritonavir, remdesivir, and molnupiravir, may not be effective in this population. While studies of longer duration are ongoing for early disease and strategies for passive immunity in immunocompromised hosts have been proposed [ 10 ], we are not aware of any ongoing studies in patients with B-cell depletion and persistent infection with SARS-CoV-2.…”

Drug treatment of COVID-19 infection

“…Most patients infected with SARS-CoV-2 achieve clearance of infectious viruses by day 10 [ 55 ]. However, in immunocompromised individuals, persistent infection with persistent viral replication has been observed, particularly in those with impaired humoral immunity [ 56 ]. This condition causes long duration of symptoms, risk of emergence of new variants with potential antiviral resistance and delays immunosuppressant treatment for the underlying conditions [ 56 , 57 ].…”

Dual antiviral therapy in haematological patients with protracted SARS‐CoV‐2 infection

“…2 Haematological treatment may be delayed until COVID-19 resolution. 3 'Protracted COVID-19/SARS-CoV-2 infection', defined as persistent positivity for SARS-CoV-2 and persistent/relapsing symptoms and radiological signs >21 days, 4 became a relevant issue in the management of haematological patients. Since the prolonged disease in this population reflects the persistence of active SARS-CoV-2, some cases of protracted COVID-19 have been treated with antivirals for an extended period of time, as recrudescence of symptoms has been described after 5 days of nirmatrelvir/ritonavir in the general population 5 and after 10 days of remdesivir in immunocompromised patients.…”