Not All Immunocompromised Patients Are at Risk for Prolonged COVID-19 Infection

One of the ongoing concerns for clinicians has been the risk associated for prolonged COVID-19 infections amongst people with immunocompromised conditions. In addition, there has a been an ongoing hypothesis that these patients may be a source of highly mutated variants of concern.

As such, investigators conducted a study looking at these 2 hypotheses. Specifically, the investigators included 5 hospitals in the Investigating Respiratory Viruses in the Acutely Ill (IVY) Network and prospectively looked at immunocompromised patients when the Omicron variant was the dominant strain circulating in the United States.

Eligible participants were identified as SARS-CoV-2-positive in the previous 14 days and had an immunocompromised condition, including either a malignancy, a solid organ or hematopoietic stem cell transplant (SOT/HSCT), a autoimmune/autoinflammatory condition on immunosuppression, AIDS, or primary immunodeficiency.

They did see a different amongst the various groups that were at higher risk of prolonged infections which was defined as 21 days or longer. “Patients with B cell dysfunction had prolonged infection compared to those with autoimmune/autoinflammatory conditions (aHR 0.28, 95% CI 0.14–0.58),” the investigators wrote.

“One of the key findings from our study was that not all immunocompromised patients are at risk for prolonged viral shedding or infection. In our patient population, it was really patients with B cell depletion or patients with B cell dysfunction,” said investigator Zoe M. Raglow, MD, fellow, University of Michigan. “And likely people living with AIDS—although that was an underrepresented group in our study. So, we couldn't really make any definitive conclusions about the AIDS group, but those were the groups that were really at risk for prolonged viral shedding or prolonged infection.”

She says this patient population may need further clinical care consideration.

“Understanding that not all immunocompromised patients are really at risk for prolonged infection, [and that] we should prospectively target patients who are at higher risk, so those are the patients with B-cell depletion or B-cell dysfunction…[These are] potentially the patients that should be targeted for enhanced antiviral strategies to try to ensure that these patients clear their infection,” Raglow said.

Secondarily, the investigators looked to see if the patients might play a role in global variants of concern.

“We looked at our immunocompromised population to see if there was evidence that variants that accumulated in these patients were then seen in global circulation…and we really didn't see evidence of that,” Raglow said. “So most of the mutations we saw in these patients we're not seeing on a global scale.”

Contagion spoke to Raglow during IDWeek and she offered further insights on the study and potential implications going forward.

Reference

Raglow Z, Surie D, Chappell J, et al. A Prospective Evaluation of SARS-CoV-2 Shedding and Evolution in Immunocompromised Hosts During the Omicron Period — IVY Network, 5 U.S. States, April 11, 2022 – February 1, 2023. October 11-14, 2023; Boston, MA. Abstract 1097.