Raglow Zoe, Lauring Adam S
Division of Infectious Diseases, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States.
Department of Microbiology and Immunology, University of Michigan, Ann Arbor, MI, United States.
Clin Chem. 2025 Jan 3;71(1):109-118. doi: 10.1093/clinchem/hvae150.
Many viruses can cause persistent infection and/or viral shedding in immunocompromised hosts. This is a well-described occurrence not only with SARS-CoV-2 but for many other viruses as well. Understanding how viruses evolve and mutate in these patients and the global impact of this phenomenon is critical as the immunocompromised population expands.
In this review, we provide an overview of populations at risk for prolonged viral shedding, clinical manifestations of persistent viral infection, and methods of assessing viral evolution. We then review the literature on viral evolution in immunocompromised patients across an array of RNA viruses, including SARS-CoV-2, norovirus, influenza, and poliovirus, and discuss the global implications of persistent viral infections in these hosts.
There is significant evidence for accelerated viral evolution and accumulation of mutations in antigenic sites in immunocompromised hosts across many viral pathogens. However, the implications of this phenomenon are not clear; while there are rare reports of transmission of these variants, they have not clearly been shown to predict disease outbreaks or have significant global relevance. Emerging methods including wastewater monitoring may provide a more sophisticated understanding of the impact of variants that evolve in immunocompromised hosts on the wider host population.
许多病毒可在免疫功能低下的宿主中引起持续感染和/或病毒脱落。这不仅是严重急性呼吸综合征冠状病毒2（SARS-CoV-2）的常见现象，许多其他病毒也如此。随着免疫功能低下人群的增加，了解病毒在这些患者体内如何进化和变异以及这一现象的全球影响至关重要。
在本综述中，我们概述了病毒长期脱落的高危人群、持续性病毒感染的临床表现以及评估病毒进化的方法。然后，我们回顾了一系列RNA病毒（包括SARS-CoV-2、诺如病毒、流感病毒和脊髓灰质炎病毒）在免疫功能低下患者中病毒进化的文献，并讨论了这些宿主中持续性病毒感染的全球影响。
有大量证据表明，在许多病毒病原体的免疫功能低下宿主中，病毒进化加速，抗原位点突变积累。然而，这一现象的影响尚不清楚；虽然有这些变异株传播的罕见报道，但它们尚未明确显示能预测疾病暴发或具有重大全球相关性。包括废水监测在内的新兴方法可能会让我们更深入地了解免疫功能低下宿主中进化的变异株对更广泛宿主群体的影响。
