SARS-CoV-2 viral clearance and evolution varies by type and severity of immunodeficiency.

Autor: Li Y; Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.; Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.; University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA., Choudhary MC; Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA., Regan J; Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.; Department of Microbiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA., Boucau J; Ragon Institute of MGH, MIT and Harvard, Cambridge, MA 02139, USA., Nathan A; Ragon Institute of MGH, MIT and Harvard, Cambridge, MA 02139, USA.; Program in Health Sciences and Technology, Harvard Medical School and Massachusetts Institute of Technology, Boston, MA 02115, USA., Speidel T; Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA., Liew MY; Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.; Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA., Edelstein GE; Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA., Kawano Y; Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA., Uddin R; Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.; Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA., Deo R; Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA., Marino C; Ragon Institute of MGH, MIT and Harvard, Cambridge, MA 02139, USA., Getz MA; Ragon Institute of MGH, MIT and Harvard, Cambridge, MA 02139, USA., Reynolds Z; Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA., Barry M; Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA., Gilbert RF; Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA., Tien D; Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA., Sagar S; Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA., Vyas TD; Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA., Flynn JP; Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA., Hammond SP; Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA., Novack LA; Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA., Choi B; Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA., Cernadas M; Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA., Wallace ZS; Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA., Sparks JA; Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA., Vyas JM; Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.; Ragon Institute of MGH, MIT and Harvard, Cambridge, MA 02139, USA., Seaman MS; Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA., Gaiha GD; Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.; Ragon Institute of MGH, MIT and Harvard, Cambridge, MA 02139, USA., Siedner MJ; Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA., Barczak AK; Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.; Ragon Institute of MGH, MIT and Harvard, Cambridge, MA 02139, USA., Lemieux JE; Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.; Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA., Li JZ; Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
Jazyk: angličtina
Zdroj: Science translational medicine [Sci Transl Med] 2024 Jan 24; Vol. 16 (731), pp. eadk1599. Date of Electronic Publication: 2024 Jan 24.
DOI: 10.1126/scitranslmed.adk1599
Abstrakt: Despite vaccination and antiviral therapies, immunocompromised individuals are at risk for prolonged severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, but the immune defects that predispose an individual to persistent coronavirus disease 2019 (COVID-19) remain incompletely understood. In this study, we performed detailed viro-immunologic analyses of a prospective cohort of participants with COVID-19. The median times to nasal viral RNA and culture clearance in individuals with severe immunosuppression due to hematologic malignancy or transplant (S-HT) were 72 and 40 days, respectively, both of which were significantly longer than clearance rates in individuals with severe immunosuppression due to autoimmunity or B cell deficiency (S-A), individuals with nonsevere immunodeficiency, and nonimmunocompromised groups ( P < 0.01). Participants who were severely immunocompromised had greater SARS-CoV-2 evolution and a higher risk of developing resistance against therapeutic monoclonal antibodies. Both S-HT and S-A participants had diminished SARS-CoV-2-specific humoral responses, whereas only the S-HT group had reduced T cell-mediated responses. This highlights the varied risk of persistent COVID-19 across distinct immunosuppressive conditions and suggests that suppression of both B and T cell responses results in the highest contributing risk of persistent infection.
Databáze: MEDLINE