Immunocompromised Patients With Persistent COVID-19 Infections May Give Rise to Variants of Concern

Investigators warn in an article in the New England Journal of Medicine that persistent COVID-19 infections in immunocompromised individuals could result in novel SARS-CoV-2 variants of concern. The partial immune response observed in these patients can create an environment for immune selection of evolutionary variants, according to the authors.

“The medical community needs to develop more precise guidelines for monitoring, treating and preventing COVID-19 infections in immunosuppressed patients to reduce both the risk to these patients and the potential emergence of variants of concern,” said Larry Corey, MD, virologist at Fred Hutchinson Cancer Research Center and leader of the COVID-19 Prevention Network, in a press release.

The authors stressed the importance of immunization for immunosuppressed patients, as well as considering the use of prophylactic monoclonal antibodies to prevent infection among those with an inadequate vaccine response. They further recommended that these patients be advised of the potential for prolonged viral shedding if they’re infected with SARS-CoV-2 and the importance of self-isolation until they receive a negative test.

“The virus can persist for weeks or months in immunocompromised individuals, leading to viruses that carry a constellation of mutations—they sometimes look like the variants of concern that are currently threatening to our control efforts,” said Morgane Rolland, PhD, a viral geneticist with the US Military HIV Research Program at Walter Reed Army Institute of Research, in the release.

Prioritizing the vaccination of these individuals is critical, but to reach this goal, access to COVID-19 vaccines must increase globally, according to the investigators. They also called for an increase in research focusing on immunocompromised groups, as immunologic studies in subsets of individuals with weakened immune systems could assist health care providers in preventing severe and prolonged infection in these groups.

“A very large number of patients have difficulty mounting a defense against COVID-19 and will benefit greatly from ongoing and focused efforts to develop more robust COVID-19 treatment and prevention strategies,” commented Myron Cohen, MD, associate vice chancellor for Global Health and Medical Affairs at the University of North Carolina, in the release.

REFERENCE

Persistent COVID-19 infections in immunocompromised people may give rise to variants of concern [news release]. EurekAlert; August 4, 2021. Accessed August 6, 2021. https://www.eurekalert.org/news-releases/924504