Intrahost viral evolution of SARS-CoV-2 infections in rheumatic versus hematological patients with severe iatrogenic immunosuppression - Report - MDSpire
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Intrahost viral evolution of SARS-CoV-2 infections in rheumatic versus hematological patients with severe iatrogenic immunosuppression
Clinical Report: Intrahost Viral Changes in SARS-CoV-2 Among Immunosuppressed
Overview
This study highlights the ongoing SARS-CoV-2 replication in severely immunocompromised patients, leading to unique intrahost mutations. A significant proportion of patients experienced relapsing COVID-19, with notable mutations primarily in the spike gene.
Background
Immunocompromised patients, particularly those with B-cell depletion, are at increased risk for severe COVID-19 outcomes and prolonged viral replication. This ongoing replication can result in genomic divergence and the emergence of novel variants, posing challenges for treatment and vaccination strategies. Understanding the mutational landscape in these patients is crucial for managing their care effectively.
Data Highlights
Characteristic
Value
Median Age
71 years
Rheumatic Disease
50%
Treated with B-cell Depleting Agent
88%
Prior COVID-19 Infection
68%
Relapsing COVID-19
65%
≥ 3 Vaccine Doses
68%
Hospitalization Rate
85%
Mortality Rate
23%
Key Findings
85% of patients were hospitalized, with a 23% mortality rate.
30 mutations were identified in the spike gene, with a prevalence of < 0.1%.
A statistically significant accumulation of intrahost single nucleotide variants (iSNVs) was observed, with an average substitution rate of 7 × 10–6 per site per day (p < 0.001).
No significant difference in substitution rates was noted between rheumatic and hematologic patients.
Relapsing COVID-19 was reported in 65% of the cohort.
Clinical Implications
Healthcare providers should be aware of the high risk of relapsing COVID-19 in severely immunocompromised patients, particularly those undergoing B-cell depletion therapy. Monitoring for unique viral mutations may be essential for tailoring treatment strategies and improving patient outcomes.
Conclusion
The findings underscore the importance of vigilant monitoring and management of COVID-19 in immunocompromised patients, given their potential as reservoirs for viral mutations. Further research is needed to understand the implications of these mutations on treatment efficacy.
