Managing Patients With COVID-19 and Common Variable Immunodeficiency

In patients with common variable immunodeficiency (CVID) who become infected with COVID-19, the disease course and risk for mortality appear to be similar to that in patients with SARS-CoV-2 infection without CVID, with vaccination shown to be safely tolerated. A chart review methodology was used to identify patients with CVID who were diagnosed with COVID-19 at the Mayo Clinic in Rochester, Minnesota. Results of the study will be presented at the American College of Allergy, Asthma & Immunology (ACAAI) 2021 Annual Scientific Meeting, November 4 to 8 in New Orleans, LA.

The researchers sought to report all outcomes among patients with CVID who were infected with SARS-CoV-2 who were treated at the Mayo Clinic between March 1, 2020, and May 20, 2021. A total of 19 individuals with CVID were diagnosed with COVID-19 at this single institution. All of the individuals received polymerase chain reaction testing, the results of which were all positive.

With all of the 19 patients surviving, 26% (5 of 19) of them were hospitalized and 21% (4 of 19) of the individuals were treated with monoclonal antibodies in the outpatient setting. In 83% (5 of 6) of the patients who were evaluated, postinfection (antinucleocapsid) seroconversion was reported. After recovering from their COVID-19 infection, 32% (6 of 19) of the patients were vaccinated against SARS-CoV-2 infection, which they tolerated well, with no significant adverse events reported. Postimmunization antispike serology was positive in the 1 individual in whom it was performed.

The study was one of the largest US case series to describe the experience at a tertiary care center responsible for the management of patients with coexisting CVID and SARS-CoV-2 infection, according to investigators.  Although CVID is a relatively common primary immunodeficiency that predisposes individuals to respiratory illness, until this study was conducted, little was known about the disease course of COVID-19 in patients with CVID, as well as how these individuals respond to SARS-CoV-2 immunization postinfection. Study findings demonstrate that the presence of CVID per se does not seem to be associated with an increased risk for mortality, investigators concluded.

Disclosure: None of the study authors have declared affiliations with biotech, pharmaceutical, and/or device companies.

Reference                                                                                                                                    

Greenmyer J, Joshi A. COVID-19 in CVID: a large hospital experience. Ann Allergy Asthma Immunol. 2021;127:S3-S17:Abstract A044. Presented at: American College of Allergy, Asthma & Immunology (ACAAI) 2021 Annual Scientific Meeting; November 4-8, 2021; New Orleans, Louisiana.