Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
Clin Infect Dis. 2021 Sep 15;73(6):e1397-e1401. doi: 10.1093/cid/ciab397.
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.
最近的病例研究强调了一个事实，即某些免疫功能低下的个体存在 SARS-CoV-2 复制时间延长、病毒在宿主内发生多次突变以及临床结局不佳的风险。免疫风险的决定因素、传染性持续时间以及免疫功能低下宿主的最佳治疗和预防策略尚不清楚。更令人担忧的是，广泛使用免疫抑制药物来治疗 COVID-19，这可能会在免疫缺陷的情况下增强和延长病毒复制。我们概述了 4 种相互关联的方法的基本原理，以期为 COVID-19 免疫功能低下患者的最佳管理带来循证医学时代：多中心发病机制和结局研究将疾病的严重程度与免疫缺陷的类型和程度联系起来，评估针对 SARS-CoV-2 疫苗的免疫反应的研究，评估单克隆抗体用于初级预防的效果的研究，以及治疗 COVID-19 的新型抗病毒药物的临床试验。
