Section of Clinical Immunology and Infectious Diseases, Division of Surgery, Inflammatory Medicine and Transplantation, Oslo University Hospital, Oslo, Norway.
Centre for Rare Disorders, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway.
Front Immunol. 2023 Apr 26;14:1124279. doi: 10.3389/fimmu.2023.1124279. eCollection 2023.
COVID-19 has shed light on the role of cellular immunity in the absence of humoral response in different patient groups. Common variable immunodeficiency (CVID) is characterized by impaired humoral immunity but also an underlying T-cell dysregulation. The impact of T-cell dysregulation on cellular immunity in CVID is not clear, and this review summarizes available literature on cellular immunity in CVID with a particular focus on COVID-19. Overall mortality of COVID-19 in CVID is difficult to assess, but seems not significantly elevated, and risk factors for severe disease mirrors that of the general population, including lymphopenia. Most CVID patients have a significant T-cell response to COVID-19 disease with possible cross-reactivity to endemic coronaviruses. Several studies find a significant but impaired cellular response to basal COVID-19 mRNA vaccination that is independent of an antibody response. CVID patients with infection only have better cellular responses to vaccine in one study, but there is no clear association to T-cell dysregulation. Cellular response wane over time but responds to a third booster dose of vaccine. Opportunistic infection as a sign of impaired cellular immunity in CVID is rare but is related to the definition of the disease. CVID patients have a cellular response to influenza vaccine that in most studies is comparable to healthy controls, and annual vaccination against seasonal influenza should be recommended. More research is required to clarify the effect of vaccines in CVID with the most immediate issue being when to booster the COVID-19 vaccine.
COVID-19 揭示了细胞免疫在不同患者群体中无体液免疫反应时的作用。常见可变免疫缺陷（CVID）的特征是体液免疫受损，但也存在潜在的 T 细胞失调。T 细胞失调对 CVID 中细胞免疫的影响尚不清楚，本综述总结了 CVID 中细胞免疫的现有文献，特别关注 COVID-19。CVID 患者 COVID-19 的总体死亡率难以评估，但似乎没有显著升高，严重疾病的危险因素与普通人群相似，包括淋巴细胞减少症。大多数 CVID 患者对 COVID-19 疾病有明显的 T 细胞反应，可能与地方性冠状病毒发生交叉反应。几项研究发现，对基础 COVID-19 mRNA 疫苗接种的细胞反应存在显著但受损，与抗体反应无关。在一项研究中，仅感染的 CVID 患者对疫苗的细胞反应更好，但与 T 细胞失调没有明确关联。细胞反应随时间推移而减弱，但对第三剂疫苗加强针有反应。作为 CVID 中细胞免疫受损的标志，机会性感染很少见，但与疾病的定义有关。CVID 患者对流感疫苗有细胞反应，在大多数研究中与健康对照组相当，应推荐每年接种季节性流感疫苗。需要进一步研究来阐明疫苗在 CVID 中的作用，最紧迫的问题是何时加强 COVID-19 疫苗。
