Prolonged persistence: exploring chronic COVID-19 infection in immunocompromised individuals

INTRODUCTION: Approximately 3 years after the first case of COVID-19 caused by severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2), albeit the significant containment of the situation, the world is still facing one of the worst pandemics of the last century. Immunosuppression is a state of transient or persistent immune deficiency leading to increased susceptibility to pathogens and an inability of the body to respond adequately to an emerging infection. EVIDENCE ACQUISITION: The string "COVID-19" OR "SARS-CoV-2" AND "immunosuppression" was used in PubMed as a search strategy. The included studies represent the published articles and what we judged as having a significant impact in this field to outline the examined topic. EVIDENCE SYNTHESIS: This manuscript reviews the course of COVID-19 infection in the context of immunosuppression associated with oncologic and nononcologic causes. An attempt is made to systematize the definition of "chronic COVID-19 infection" and therapeutic algorithms in these cases are discussed. CONCLUSIONS: Immunosuppressed patients may have a prolonged course of SARS-CoV-2 infection that worsens prognosis and is associated with the emergence of new strains. The question of the duration of infection to be classified as chronic or prolonged is still unclear, and a proposed cut-off of more than 30 days is subject to further discussion. Published articles describe mainly individual clinical cases or case series, and the treatment applied varies considerably, as there is no consensus opinion. Remdesivir monotherapy is frequently associated with treatment failure, but the combination of antivirals with antibody -based therapeutics is associated with the highest rate of viral clearance and holds promise.