Improving the Outcomes of Immunocompromised Patients With Coronavirus Disease 2019

Recent case studies have highlighted the fact that certain immunocompromised individuals are at risk for prolonged SARS-CoV-2 replication, intrahost viral evolution of multiply-mutated variants, and poor clinical outcomes. The immunologic determinants of this risk, the duration of infectiousness, and optimal treatment and prevention strategies in immunocompromised hosts are ill defined. Of additional concern is the widespread use of immunosuppressive medications to treat COVID-19, which may enhance and prolong viral replication in the context of immunodeficiency. We outline the rationale for 4 interrelated approaches to usher in an era of evidence-based medicine for optimal management of immunocompromised patients with COVID-19: multicenter pathogenesis and outcomes studies to relate the risk of severe disease to the type and degree of immunodeficiency, studies to evaluate immunologic responses to SARS-CoV-2 vaccines, studies to evaluate the efficacy of monoclonal antibodies for primary prophylaxis, and clinical trials of novel antiviral agents for the treatment of COVID-19.

Automated summary

Recent case studies have shown that immunocompromised individuals are at risk for prolonged SARS-CoV-2 replication, viral evolution, and poor clinical outcomes. The immunologic determinants of this risk, optimal treatment strategies, and use of immunosuppressive medications for COVID-19 in immunocompromised hosts are not well understood. Studies are needed to better understand these factors and improve management of these patients.