COVID-19 relapse associated with SARS-CoV-2 evasion from CD4+ T-cell recognition in an agammaglobulinemia patient

A 25-year-old patient with a primary immunodeficiency lacking immunoglobulin production experienced a relapse after a 239-day period of persistent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Viral genetic sequencing demonstrated that SARS-CoV-2 had evolved during the infection period, with at least five mutations associated with host cellular immune recognition. Among them, the T32I mutation in ORF3a was found to evade recognition by CD4(+) T cells. The virus found after relapse showed an increased proliferative capacity in vitro. SARS-CoV-2 may have evolved to evade recognition by CD4(+) T cells and increased in its proliferative capacity during the persistent infection, likely leading to relapse. These mutations may further affect viral clearance in hosts with similar types of human leukocyte antigens. The early elimination of SARS-CoV-2 in immunocompromised patients is therefore important not only to improve the condition of patients but also to prevent the emergence of mutants that threaten public health.

Automated summary

A 25-year-old patient with primary immunodeficiency experienced a relapse of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection after a 239-day period. Genetic sequencing revealed that the virus had evolved during the infection, with mutations associated with evasion of immune recognition. The relapsed virus showed increased proliferative capacity. It is important to eliminate SARS-CoV-2 early in immunocompromised patients to prevent the emergence of mutants and improve patient outcomes.