SARS-CoV-2 variants and immunosuppression

Simon Collins, HIV i-Base

A review in the NEJM includes case reports of SARS-CoV-2 infections in people with immunosuppression.

It is notable for a higher risk for prolonged infection – and that this had enabled viral evolution in these individuals that was similar to main variants of interest (VOI) and concern (VOC).

These cases included recipients of solid organ transplantation and people with uncontrolled HIV infection. It also suggested that certain forms of immunosuppression might drive the development of mutations.

Prioritised access to vaccines is recommended for both personal protection and to limit the risk of prolonged infection – and also the importance of isolation until viral shedding is proved negative.

The article also discusses the potential role of monoclonal antibody treatment for people who do not generate immune responses to vaccines, recognising that these often have limited activity against later variants.


Corey L et al. SARS-CoV-2 Variants in Patients with Immunosuppression. N Engl J Med 2021; 385:562-566. DOI: 10.1056/NEJMsb2104756. (5 August 2021).

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