Antiviral therapies for the management of persistent coronavirus disease 2019 in immunocompromised hosts: A narrative review

• Published in: Transplant infectious disease 2024-06, Vol.26 (3), p.e14301-n/a
• Main Authors: Kinsella, Paul M., Moso, Michael A., Morrissey, Catherine Orla, Dendle, Claire, Guy, Stephen, Bond, Katherine, Sasadeusz, Joseph, Slavin, Monica A.
• Format: Article
• Language: English
• Subjects: Antibodies; Antibodies, Neutralizing - therapeutic use; antibody; antiviral; Antiviral agents; Antiviral Agents - therapeutic use; Antiviral drugs; CD20 antigen; Coronaviruses; COVID-19; COVID-19 - immunology; COVID-19 Drug Treatment; Disease management; Drug Therapy, Combination; Humans; immunocompromised; Immunocompromised Host; Immunocompromised hosts; Malignancy; Narratives; persistent; prolonged; Respiratory diseases; SARS-CoV-2 - immunology; SARS‐CoV‐2; Severe acute respiratory syndrome; Severe acute respiratory syndrome coronavirus 2; Therapy; Viral diseases
• ISSN: 1398-2273; 1399-3062; 1399-3062
• DOI: 10.1111/tid.14301

Antiviral agents with activity against severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) have played a critical role in disease management; however, little is known regarding the efficacy of these medications in the treatment of SARS‐CoV‐2 infection in immunocompromised patients, particularly in the management of persistent SARS‐CoV‐2 positivity. This narrative review discusses the management of persistent coronavirus disease 2019 in immunocompromised hosts, with a focus on antiviral therapies. We identified 84 cases from the literature describing a variety of approaches, including prolonged antiviral therapy (n = 11), combination antivirals (n = 13), and mixed therapy with antiviral and antibody treatments (n = 60). A high proportion had an underlying haematologic malignancy (n = 67, 80%), and were in receipt of anti‐CD20 agents (n = 51, 60%). Success was reported in 70 cases (83%) which varied according to the therapy type. Combination therapies with antivirals may be an effective approach for individuals with persistent SARS‐CoV‐2 positivity, particularly those that incorporate treatments aimed at increasing neutralizing antibody levels. Any novel approaches taken to this difficult management dilemma should be mindful of the emergence of antiviral resistance.