Persistent COVID-19 in Immunocompromised Patients - Israeli Society of Infectious Diseases Consensus Statement on Diagnosis and Management.

BACKGROUND: Immunocompromised patients with impaired humoral immunity are at risk for persistent COVID-19 (pCOVID), a protracted symptomatic disease with active viral replication.

OBJECTIVES: To establish a national consensus statement on the diagnosis, treatment, management, isolation, and prevention of pCOVID in adults.

SOURCES: We base our suggestions on the available literature, our own experience and clinical reasoning.

CONTENT: Literature on the treatment of pCOVID is scarce and consists of few case-reports and case series. The available studies provide low-quality evidence for monoclonal antibodies, convalescent plasma, anti-viral drugs, and immunomodulators. Different combination therapies are described. Continuous viral replication and anti-viral treatment may lead to the development of mutations that confer resistance to therapy.

IMPLICATIONS: To reduce the risk of resistance and improve outcomes, we suggest treating pCOVID with a combination of antibody-based therapy and two anti-viral drugs for a duration of five to ten days. Immunomodulatory therapy can be added in patients with an inflammatory clinical picture. In case of treatment failure or relapse, prolonged anti-viral treatment can be considered. For the prevention of pCOVID we suggest active and passive vaccination, as well as early initiation of treatment for acute COVID-19. Additional research on pCOVID treatment is urgently needed.