Prolonged COVID-19 infection among immune compromised individuals may generate multiple mutations of SARS-CoV-2, providing a path to more transmissible or virulent variants of concern. Researchers describe some implications of SARS-CoV-2 evolution in immunosuppressed patients in a new commentary in the New England Journal of Medicine.
Immunosuppressed individuals, such as organ transplant recipients or people living with HIV, are at risk of persistent COVID-19 infections. Case reports indicate the virus can make rapid evolutionary jumps in the course of these long illnesses, including distinct mutations to the coronavirus Spike that could play a part in antibody recognition of the virus. According to commentary co-author Dr. Morgane Rolland, a viral geneticist with the Military HIV Research Program at the Walter Reed Army Institute of Research, a large number of mutations is a hallmark of COVID variants of concern.
“We have seen a succession of variants of concern spread in 2021, we don’t know how they emerged but what they all have in common is an array of Spike mutations, a pattern that is also seen in SARS-CoV-2 infections in immunocompromised individuals,” said Dr. Rolland.
The authors mention some clinical and public health implications of SARS-CoV-2 evolution in immune compromised patients and recommend strategies to limit harmful outcomes, including prioritizing immunosuppressed individuals for vaccination and pursuing preventive monoclonal antibodies for those who cannot mount a robust antibody response to vaccines.
Read the full commentary here: https://www.nejm.org/doi/full/10.1056/NEJMsb2104756?query=featured_coronavirus#article_references