Kinetics of SARS-CoV-2 viral RNA and culturable virus varied among immunocompromised groups. (A) Degradation of viral RNA from the upper respiratory tract is shown. The lower level of quantification (LLOQ) is 10 copies/ml. (B) Kaplan-Meier estimates of upper respiratory viral clearance are shown (viral load below LLOQ) and overall log-rank P values were presented. For (A) and (B), n = 12, 13, 31, and 184 for the S-HT, SA, NS, and non-immunocompromised groups, respectively. (C) Dynamics of culturable upper respiratory viruses were quantified as TCID50 values. (D) Kaplan-Meier estimates of clearance of culturable virus from the upper respiratory tract were presented, along with overall log-rank P values. For (C) and (D), n = 12, 12, 31, and 184 for the S-HT, SA, NS, and non-immunocompromised groups, respectively. Credit: Scientific translational medicine (2024). DOI: 10.1126/scitranslmed.adk1599
People who are immunocompromised are likely to experience worse outcomes from COVID-19 and may have a less robust response to vaccination than people who are not immunocompromised. But the term “immunocompromised” refers to a wide range of conditions, and not all patients in this category are at the same risk.
Researchers at Mass General Brigham studied a population of 56 immunocompromised individuals including patients who were severely immunocompromised due to hematologic malignancies/organ transplant or autoimmune/B cell deficiency as well as non-severely immunocompromised patients. The team compared these groups with each other and with non-immunocompromised patients.
They found that patients’ ability to clear the virus differed depending on the extent of their immunosuppression. Patients who were immunocompromised due to hematological malignancy or organ transplantation were most likely to suffer from chronic and prolonged infection. This finding suggests the importance of T cells in clearing SARS-CoV-2 infection, which has implications for patient monitoring and improved vaccine design. Severely immunocompromised participants also had a higher risk of developing resistance to therapeutic monoclonal antibodies.
The study is published in the journal Scientific translational medicine.
“Providers and patients should be aware that prolonged symptoms may mean persistent COVID-19 illness that requires additional testing and potential treatment,” said corresponding author Jonathan Li, MD, of the Division of Infectious Diseases from Brigham and Women’s Hospital.
Patients with a history of organ transplantation or hematological malignancy had the greatest delay in viral clearance; patients with B-cell immunodeficiency were at intermediate risk; and the 31 study patients with mild, non-severe immunosuppression, such as those with autoimmune diseases receiving anti-tumor necrosis factor (TNF) therapy, had viral shedding dynamics similar to those of participants not immunocompromised.
“Although our sample size is limited, these results provide reassurance that most patients with mild to moderate immunosuppression (including those on B cell-depleting therapy) will be able to clear the virus during the acute phase. of infection,” Li said.
More information:
Yijia Li et al, the clearance and course of the SARS-CoV-2 virus vary depending on the type and severity of immunodeficiency, Scientific translational medicine (2024). DOI: 10.1126/scitranslmed.adk1599
Provided by Mass. General Brigham
Quote: New study highlights varied risk of persistent COVID-19 infection in immunocompromised patients (January 24, 2024) retrieved January 24, 2024 from
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