Persistent COVID-19 in Immunocompromised Patients - Israeli Society of Infectious Diseases Consensus Statement on Diagnosis and Management.

BACKGROUND

Immunocompromised patients with impaired humoral immunity are at risk for persistent COVID-19 (pCOVID), a protracted symptomatic disease with active viral replication.

OBJECTIVES

To establish a national consensus statement on the diagnosis, treatment, management, isolation, and prevention of pCOVID in adults.

SOURCES

We base our suggestions on the available literature, our own experience and clinical reasoning.

CONTENT

Literature on the treatment of pCOVID is scarce and consists of few case-reports and case series. The available studies provide low-quality evidence for monoclonal antibodies, convalescent plasma, anti-viral drugs, and immunomodulators. Different combination therapies are described. Continuous viral replication and anti-viral treatment may lead to the development of mutations that confer resistance to therapy.

IMPLICATIONS

To reduce the risk of resistance and improve outcomes, we suggest treating pCOVID with a combination of antibody-based therapy and two anti-viral drugs for a duration of five to ten days. Immunomodulatory therapy can be added in patients with an inflammatory clinical picture. In case of treatment failure or relapse, prolonged anti-viral treatment can be considered. For the prevention of pCOVID we suggest active and passive vaccination, as well as early initiation of treatment for acute COVID-19. Additional research on pCOVID treatment is urgently needed.

Informations de copyright

Copyright © 2024. Published by Elsevier Ltd.