Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy.
Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.
Front Immunol. 2023 Feb 8;14:1093385. doi: 10.3389/fimmu.2023.1093385. eCollection 2023.
CVID patients present an increased risk of prolonged SARS-CoV-2 infection and re-infection and a higher COVID-19-related morbidity and mortality compared to the general population. Since 2021, different therapeutic and prophylactic strategies have been employed in vulnerable groups (vaccination, SARS-CoV-2 monoclonal antibodies and antivirals). The impact of treatments over the last 2 years has not been explored in international studies considering the emergence of viral variants and different management between countries.
A multicenter retrospective/prospective real-life study comparing the prevalence and outcomes of SARS-CoV-2 infection between a CVID cohort from four Italian Centers (IT-C) and one cohort from the Netherlands (NL-C), recruiting 773 patients.
329 of 773 CVID patients were found positive for SARS-CoV-2 infection between March 1, 2020 and September 1 2022. The proportion of CVID patients infected was comparable in both national sub-cohorts. During all waves, chronic lung disease, "complicated" phenotype, chronic immunosuppressive treatment and cardiovascular comorbidities impacted on hospitalization, whereas risk factors for mortality were older age, chronic lung disease, and bacterial superinfections. IT-C patients were significantly more often treated, both with antivirals and mAbs, than NL-C patients. Outpatient treatment, available only in Italy, started from the Delta wave. Despite this, no significant difference was found for COVID-19 severity between the two cohorts. However, pooling together specific SARS-CoV-2 outpatient treatments (mAbs and antivirals), we found a significant effect on the risk of hospitalization starting from Delta wave. Vaccination with ≥ 3 doses shortened RT-PCR positivity, with an additional effect only in patients receiving antivirals.
The two sub-cohorts had similar COVID-19 outcomes despite different treatment approaches. This points out that specific treatment should now be reserved for selected subgroups of CVID patients, based on pre-existing conditions.
与普通人群相比，CVID 患者 SARS-CoV-2 感染持续时间延长、再感染风险增加，COVID-19 相关发病率和死亡率更高。自 2021 年以来，在弱势群体中采用了不同的治疗和预防策略（疫苗接种、SARS-CoV-2 单克隆抗体和抗病毒药物）。考虑到病毒变异和国家间管理的不同，在国际研究中尚未探讨过去 2 年治疗的影响。
一项多中心回顾性/前瞻性真实世界研究，比较了来自意大利四个中心的 CVID 队列（IT-C）和来自荷兰的一个队列（NL-C）的 SARS-CoV-2 感染的患病率和结局，共纳入 773 例患者。
2020 年 3 月 1 日至 2022 年 9 月 1 日期间，773 例 CVID 患者中有 329 例 SARS-CoV-2 感染阳性。两个国家亚队列中 CVID 患者感染的比例相似。在所有波次中，慢性肺部疾病、“复杂”表型、慢性免疫抑制治疗和心血管合并症影响住院治疗，而死亡的危险因素为年龄较大、慢性肺部疾病和细菌合并感染。与 NL-C 患者相比，IT-C 患者接受抗病毒药物和 mAb 治疗的比例显著更高。仅在意大利提供的门诊治疗从 Delta 波开始。尽管如此，两个队列之间 COVID-19 严重程度没有显著差异。然而，将特定的 SARS-CoV-2 门诊治疗（mAb 和抗病毒药物）汇总在一起，我们发现从 Delta 波开始，住院风险有显著降低。接种≥3 剂疫苗可缩短 RT-PCR 阳性时间，仅对接受抗病毒药物治疗的患者有额外效果。
尽管治疗方法不同，但两个亚队列的 COVID-19 结局相似。这表明现在应根据患者的基础疾病情况，为 CVID 患者中的特定亚组保留特定治疗。
