COVID-19 in complex common variable immunodeficiency patients affected by lung diseases

Area of Science:

• Immunology
• Infectious Diseases
• Pulmonology

Background:

• Severe COVID-19 risk factors in the general population include old age, male sex, hypertension, obesity, and chronic diseases.
• Chronic lung diseases are recognized risk factors for hospitalization and ICU admission.
• Common Variable Immunodeficiency (CVID) is the most prevalent symptomatic primary antibody defect.

Purpose of the Study:

• To determine if chronic lung diseases, such as bronchiectasis and interstitial diseases, pose a risk for severe SARS-CoV-2 infection in CVID patients.
• To compare severe COVID-19 risk in CVID patients with and without chronic lung involvement.

Main Methods:

• A meta-analysis of 88 CVID cases from large cohorts and case reports was conducted.
• Clinical presentations of SARS-CoV-2 infection in CVID patients were analyzed.
• Risk factors for severe COVID-19 in CVID patients were compared to the general population.

Main Results:

• CVID patients with chronic lung involvement had a significantly increased risk for severe COVID-19 compared to those without lung diseases (50% vs. 28%, RR 1.75).
• In contrast to the general population, age and metabolic comorbidities were not identified as risk factors for severe COVID-19 in this CVID patient cohort.
• The P-value for the increased risk was P=0.043, with a 95% confidence interval of 1.04--2.92.

Conclusions:

• Underlying chronic lung diseases, not age, represent a significant risk factor for severe COVID-19 in individuals with CVID.
• SARS-CoV-2 positive CVID patients with chronic lung diseases require prompt therapeutic intervention, irrespective of their age.